You are here

Responses

Article menu

Download PDFPDF

XML
Mental health
Research
Pharmacological and non-pharmacological treatments for major depressive disorder: review of systematic reviews
Compose a Response to This Article
Compose Response

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests

PLEASE NOTE:

  • A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
  • We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
  • Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
  • By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

  • Published on: 30 June 2017
    Response to comment by Prof. Hughes

    Dr Hughes raises an important point that we also address in discussing limitations of the study. We did not take meta-analyses into consideration that had combined studies with inactive treatments and treatment as usual (TAU) as control interventions. We based this decision primarily on methodological reasons. TAU varies widely across patients and settings and can include antidepressant or behavioral treatments. Therefore, equating TAU with placebo treatment or waiting list seemed problematic for us.

    Nevertheless, Dr. Hughes’ point is well taken. TAU is an important reference standard, particularly in pragmatic studies because it reflects real-world conditions. In a meta-analysis, however, TAU is difficult to handle especially when the components of TAU across individual trials are not well documented. Using TAU in a meta-analysis often comes down to combining apples and oranges without being able to tell which treatments are the apples and which are the oranges.

    Dr. Hughes also argues that patients on waiting lists cannot be prevented from getting some form of treatment. We agree but view this as a general issue of contamination that is almost impossible to control, particularly in pragmatic studies. The fact that, in our study, patients on active treatments had substantially larger treatment effects than those on waiting lists makes us think that contamination issues probably did not have much impact.

    Conflict of Interest:
    None declared.
  • Published on: 26 June 2017
    Why exclude treatment-as-usual?

    This fascinating paper has a serious flaw; the exclusion of all studies with treatment-as-usual (TAU) comparison conditions. The authors justify this decision by stating that TAU is not standardized and cannot be considered an inactive condition. However, the difference between TAU and two included control conditions (wait-list and no care) may be predominantly semantic. Patients randomized to no care or wait-list cannot be forbidden from continuing to participate in the healthcare system and may receive exactly the treatments that they would usually receive if they were not enrolled in a clinical trial; that is, treatment as usual. No care and wait-list may not be any more standardized than TAU. Furthermore, TAU is what happens in the real world. Given the state of the mental health infrastructure in many countries, behavioural treatments are often compared against TAU to see if they are beneficial compared to what the patient would receive otherwise.

    Conflict of Interest:
    None declared.