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So, for several years the actual efficacy of antidepressants has been called into question. There's lots of reasons for this, some related to the general replicability crisis, but in general it followed from reanalyses of datasets suggesting the efficacy of antidepressants is significantly lower than previously thought, and some might not have any efficacy at all. At the same time, there's been acknowledgment that the forms of illness encountered in reality don't really map on well to diagnostic categories. So rather than major depression and generalized anxiety disorder, it's more like there are levels of general distress, and specific problems with low positive emotion, or high negative emotion, or arousal. This has contributed to things like the NIH RDoC initiative. These two things have sort of combined to lead to a lot of questions about what antidepressants are actually doing, in terms of how it's affecting dimensions of mood and other areas of functioning, thought of in a more detailed way. So in this study rather than targeting a specific diagnostic population, they did a randomized controlled trial of a heterogeneous group of patients, and then assessed antidepressant effects on distress and well-being in a more detailed, comprehensive way than the typical diagnostic assessment. The results aren't really surprising but are interesting to think about in the context of these issues. For instance, it's not surprising that antidepressant effects might manifest in well-being or anxiety measures, because general anxiety and depression measures can be correlated as high as .8 or .9, and well-being, while less correlated, still tends to tag along. From a replicability standpoint it raises some interesting issues because there's sort of a "fishing expedition" given all the measures, even though things were preregistered, which is worth some discussion, but the effects are all in the anticipated direction even if not significant, raising the question of whether or not p-values really are the most important thing in general. Overall the study is one piece, but it fits together with a more general body of evidence suggesting that antidepressants are really fuzzy in their effects, and might better be thought of as "antidistress" agents, or as having a general calming effect. Not mind-blowing, but does contradict the way the meds are typically portrayed in public discussion. |