Should We Treat Depression with drugs or psychological interventions? A Reply to Ioannidis

Our most important criticism is Ioannidis’ basic underlying argument about antidepressants that if the existing evidence is imperfect and methods can be criticized, then this proves that antidepressant are not efficacious. He presents no credible evidence that antidepressants have zero effect size. Valid arguments can point out difficulties with the data but do not prove that a given drug had no efficacy. Indeed better evidence might prove it was more efficacious that originally found.We find no empirical or ethical reason why psychiatrists should not try to help depressed patients with drugs and/or with psychotherapeutic/behavioral treatments given evidence of efficacy even though our treatment knowledge has limitations. The immense suffering of patients with major depression leads to ethical, moral, professional and legal obligations to treat patients with the best available tools at our disposal, while diligently and actively monitoring for adverse effects and actively revising treatment components as necessary.We were asked to write a reply to the Ioannidis's paper "Effectiveness of antidepressants; an evidence based myth constructed from a thousand controlled trials," a critique extended to behavioral and psychotherapies, as well [1]. However, after agreeing to this task, we realized that the paper was an excellently written paper and that we agreed with most of Ioannidis's points and except one point: his statement that both antidepressants and psychotherapeutic/behavioral treatments have no efficacy. A brief summary of Ioannidis's paper is as follows:Ioannidis says that antidepressant use is based on "pseudo-evidence-based medicine" and that there is "no reason to take antidepressants." He characterizes antidepressant effectiveness as a "myth" that is misleading the public into believing that this class of medicine is useful, and he builds his argument along several lines. Ioannidis quotes evidence that drug companies fail to publish some clinical trials, oft