On 2015 Oct 28, Peter Gøtzsche commented:

Although the authors caution against “the possibility of publication bias”, they conclude that drugs, in particular SSRIs, appear effective. I don’t agree. The trials were of very poor quality, and the effect decreased so dramatically with the number of patients in the trial that any meta-analysis of these data would be grossly unreliable. The authors nonetheless meta-analysed their data and reported a relative risk of nonresponse of 0.64 (95% CI 0.57 to 0.73) on the Global Impression Scale. But they also showed in a figure that the largest trials found an effect close to zero.

Another problem is that all the scales appear to have been rated by the clinicians and not the patients. For depression trials, the standardised mean difference in trials that had both psychiatrists and patients as observers was around 0.25 when the psychiatrists evaluated the effect but only 0.05 when the patients were their own judges (1).

An additional problem is that many trials use the last observation carried forward, which would be expected to bias these trials further since the patients’ abstinence symptoms can be depression and anxiety, causing them to drop out, against which the effect of the active drug is judged (2). This is an unfair comparison.

In my opinion, drugs should not be used for social phobia. Psychotherapy works well and the patients need to learn how to cope with their anxiety rather than being emotionally numbed by drugs. It is the fact not only for benzodiazepines but also for SSRIs that about half of the patients have difficulty stopping again, as they become dependent on them (1).

1 Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.

2 Rosenbaum JF, Fava M, Hoog SL, et al. Selective serotonin reuptake inhibi¬tor discontinuation syndrome: a randomised clincial trial. Biol Psychiatry 1998;44:77-87.

On 2015 Oct 28, Peter Gøtzsche commented:

Although the authors caution against “the possibility of publication bias”, they conclude that drugs, in particular SSRIs, appear effective. I don’t agree. The trials were of very poor quality, and the effect decreased so dramatically with the number of patients in the trial that any meta-analysis of these data would be grossly unreliable. The authors nonetheless meta-analysed their data and reported a relative risk of nonresponse of 0.64 (95% CI 0.57 to 0.73) on the Global Impression Scale. But they also showed in a figure that the largest trials found an effect close to zero.

Another problem is that all the scales appear to have been rated by the clinicians and not the patients. For depression trials, the standardised mean difference in trials that had both psychiatrists and patients as observers was around 0.25 when the psychiatrists evaluated the effect but only 0.05 when the patients were their own judges (1).

An additional problem is that many trials use the last observation carried forward, which would be expected to bias these trials further since the patients’ abstinence symptoms can be depression and anxiety, causing them to drop out, against which the effect of the active drug is judged (2). This is an unfair comparison.

In my opinion, drugs should not be used for social phobia. Psychotherapy works well and the patients need to learn how to cope with their anxiety rather than being emotionally numbed by drugs. It is the fact not only for benzodiazepines but also for SSRIs that about half of the patients have difficulty stopping again, as they become dependent on them (1).

1 Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.

2 Rosenbaum JF, Fava M, Hoog SL, et al. Selective serotonin reuptake inhibi¬tor discontinuation syndrome: a randomised clincial trial. Biol Psychiatry 1998;44:77-87.