Article
Efficacy and adverse drug reactions of antidepressants from the perspective of laypersons
Wirksamkeit und unerwünschte Arzneimittelwirkungen von Antidepressiva aus der Sicht von Laien
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Authors
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Katharina Apel
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Jennifer Scheel-Barteit
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Thomas Kühlein
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Maria Sebastiao
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| Published: | November 13, 2024 |
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Outline
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Background: The prescription volume of antidepressants increased by over 40% between 2009 and 2018 despite controversial discussions regarding their efficacy. It is well known that physicians and patients hardly know the effect sizes for benefits and harms of medical procedures including medication. When asked to guess, both tend to overestimate medication benefits and underestimate harms. In this study, we aimed to explore how laypersons assess the efficacy of antidepressants and their adverse drug reactions (ADRs) and which improvement they expect from an antidepressant to accept certain ADRs.
Materials and Methods: We conducted a cross-sectional online survey in Germany using RedCap. We recruited participants via different channels such as psychotherapists, support groups, or general practices. Laypersons without and with depression (antidepressants yes/no) could take part in the study. Based on a case scenario, participants were asked to estimate the efficacy of the antidepressant citalopram in the treatment of a moderate depressive episode and to estimate the frequency of various ADRs. Depression was operationalized with the Montgomery Åsberg Depression Rating Scale (MADRS; range 60 points, higher values meaning more severe depression). Participants had to rate how much depression severity would have to improve to accept certain ADRs.
Results: In total, N = 208 participants (female: 144, male: 64) completed the survey of which 44 took antidepressants. Participants assumed that moderate depression would improve on average by M = 9.92 (SD = 11.05) points on the MADRS with antidepressants. Participants demanded a reduction of depression severity of M = 19.33/60 points (SD = 9.18) for them to be willing to accept the side effect of “sleep disturbance” alone and stated that they would not accept the ADR ‘seizures’ under any circumstances (M = 23.45, SD = 9.35).
Conclusion: In line with other studies, participants overestimated the efficacy of antidepressants, while underestimating the ADRs. The assumed improvement was far higher than the actual efficacy of antidepressants as seen in RCTs. We propose that the minimal clinically important difference (MCID) should be extended to include the subjective view of the patients and be more strongly included in future treatment decision.
