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A new study finds the benefits of talk therapy for depression have been overstated. This comes several years after a similar study reached the same conclusion about antidepressant drugs. NPR's Jon Hamilton explains why both forms of depression treatment may be less effective than scientific literature suggests.
JON HAMILTON, BYLINE: In 2008, drugs for depression took a major hit. That was the year a team led by Erick Turner at Oregon Health and Science University found that research on these drugs suffered from a form of bias. Studies showing that the drugs didn't work rarely got published, so when researchers analyzed the literature on depression drugs, they got a distorted picture.
ERICK TURNER: The overall effect was to inflate the apparent benefits of the drugs that made the drugs look better than they actually were.
HAMILTON: Antidepressants did work, just not as well as the published studies had indicated. It's not surprising that this publication bias exists. Both scientists and scientific journals tend to place a higher value on research that gets positive results. Turner says his analysis of depression drug studies had an unfortunate side effect. It was used by critics of antidepressants to suggest that people with depression should avoid drug treatment.
TURNER: There was a wave of just simple antidepressant bashing that went on and has continued.
HAMILTON: Turner was also unhappy that his study was used to suggest that people with depression should choose talk therapy over drugs.
TURNER: Why should we be recommending this other treatment when it might be just as fraught with publication bias as the drug literature is?
HAMILTON: So Turner and a team of researchers decided to find out. The team reviewed 55 National Institutes of Health grants awarded between 1972 and 2008. The grants funded clinical trials of psychotherapy for depression. Turner says the results of nearly a quarter of these trials never got published.
TURNER: And when you bring in the unpublished data, it brings down the apparent efficacy of psychotherapy for depression.
HAMILTON: The same way it brought down the apparent efficacy of drugs for depression. Steven Hollon of Vanderbilt University is one of the new study's co-authors. He says the results should reduce unjustified criticisms of drug treatment.
STEVEN HOLLON: There was a bit of a negative vibe for medications when the notion of publication bias came out, and this article, if anything, kind of evens up the playing field.
HAMILTON: And Hollon says the presence of publication bias is not an indictment of either talk therapy or antidepressant drugs.
HOLLON: In both cases, there are enough good data there to tell us that those treatments work. They're efficacious. They're just not as efficacious as we think they probably are. In both cases, the true efficacy is probably about a third less than we think it is.
HAMILTON: Hollon says the published literature may have led psychiatrists and psychologists to be too optimistic about the depression treatments they offer. But he says that's less likely to be a problem for patients.
HOLLON: When people are depressed, they usually underestimate. They're usually unduly pessimistic, and the biggest problem we have in depression's getting people to avail themselves of treatment, whatever it is. And if anything, it takes people longer to get into treatment than would be good for them.
HAMILTON: Of course, publication bias isn't limited to depression treatments. Kay Dickersin of Johns Hopkins says it's a widespread problem in the research world.
KAY DICKERSIN: We're rewarded for getting papers out, for finding results that will bring attention to our universities and to ourselves, et cetera. So that doesn't help. We aren't rewarded for being honest. We're rewarded for making a splash.
HAMILTON: And Dickersin says that presents a challenge to both doctors and their patients.
DICKERSIN: I think the question that's really arisen is, how much of what's out there should we believe, which is kind of a scary thought.
HAMILTON: Dickersin says one solution is to have research grants include a requirement that all study results be made public even if they're never published. The new research appears in the journal PLOS ONE. Jon Hamilton, NPR News.
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