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And it only becomes significant in the most severe depression 6.
And even the effects found are only noticed by doctors, not the patients themselves 7.
The effect size of antidepressants is clinically insignificant 5.
If you’re a geek about these sorts of things, you know that a few studies have found non-significant advantages for Prozac and Paxil over older drugs like clomipramine, and marginally-significant advantages for Effexor over SSRIs.
But conventional wisdom is that tricyclics can be even more powerful than SSRIs for certain very severe hospitalized depression cases, and a lot of people think MAOIs worked better than anything out there today.
SSRIs were the first class of antidepressants that mostly avoided these problems and so were pretty well-placed to launch a prescribing explosion even apart from being pushed by Big Pharma. There is large publication bias in the antidepressant literature – True, but not as important as some people think People became more aware of publication bias a couple of years after serious research into antidepressants started, and it’s not surprising that these were a prime target.
When this issue rose to scientific consciousness, several researchers tried to avoid the publication bias problem by using only FDA studies of antidepressants.