The Efficacy of Paroxetine and Placebo in Treating Anxiety and Depression: A Meta-Analysis of Change on the Hamilton Rating Scales

Background: Previous meta-analyses of published and unpublished trials indicate that antidepressants provide modest benefits compared to placebo in the treatment of depression; some have argued that these benefits are not clinically significant. However, these meta-analyses were based only on trials submitted for the initial FDA approval of the medication and were limited to those aimed at treating depression. Here, for the first time, we assess the efficacy of a selective serotonin reuptake inhibitor (SSRI) in the treatment of both anxiety and depression, using a complete data set of all published and unpublished trials sponsored by the manufacturer. Methods and Findings: GlaxoSmithKline has been required to post the results for all sponsored clinical trials online, providing an opportunity to assess the efficacy of an SSRI (paroxetine) with a complete data set of all trials conducted. We examined the data from all placebo-controlled, double-blind trials of paroxetine that included change scores on the Hamilton Rating Scale for Anxiety (HRSA) and/or the Hamilton Rating Scale for Depression (HRSD). For the treatment of anxiety (k = 12), the efficacy difference between paroxetine and placebo was modest (d = 0.27), and independent of baseline severity of anxiety. Overall change in placebo-treated individuals replicated 79% of the magnitude of paroxetine response. Efficacy was superior for the treatment of panic disorder (d = 0.36) than for generalized anxiety disorder (d = 0.20). Published trials showed significantly larger drug-placebo differences than unpublished trials (d’s = 0.32 and 0.17, respectively). In depression trials (k = 27), the benefit of paroxetine over placebo was consistent with previous meta-analyses of antidepressant efficacy (d = 0.32). Conclusions: The available empirical evidence indicates that paroxetine provides only a modest advantage over placebo in treatment of anxiety and depression. Treatment implications are discussed

Decision making and binge drinking: a longitudinal study

Behavioral decision making, as measured by the Iowa Gambling Task (IGT) is found to be diminished in individuals with substance dependence and other types of disinhibitory psychopathology. However, little is known regarding the relation between heavy alcohol use and decision-making skills in young adults. This study therefore investigated whether binge drinking is related to disadvantageous decision making, as measured by the IGT. We also examined the relation between decision making and impulsivity. Latent class growth analysis was used to classify college students into 4 groups (each group n=50, 50% male), based on their binge drinking trajectories over a 2-year time period (precollege through second year of college). Participants were 200 college students, divided in 4 subgroups: (1) low binge drinkers, (2) stable moderate binge drinkers, (3) increasing binge drinkers, and (4) stable high binge drinkers. A measure of decision making, the IGT, impulsivity questionnaires, and multiple indicators of heavy alcohol use were included. The stable high binge-drinking group made less advantageous choices on the IGT than the low binge-drinking group. Impulsivity was not related to decision-making performance. Decision-making performance did not differ by gender, but deck preferences and decision time patterns did differ; women preferred low frequency, high amount punishments to a greater extent than men. Although disadvantageous decision making is related to binge-drinking patterns in emerging adulthood, this relation is independent of impulsivity. Additionally, the association appears attributable to those who engage in heavy (binge) drinking at an early age, but not to age of onset of drinking in genera

Decision making and response inhibition as predictors of heavy alcohol use: a prospective study

Very few studies have investigated the "real world" prospective, predictive value of behavioral instruments used in laboratory studies to test decision-making abilities or impulse control. The current study examines the degree to which 2 commonly used decision-making/impulse control measures prospectively predict (heavy) alcohol use in a sample of college students. Two hundred healthy young adults (50% women) performed the Iowa Gambling Task (IGT) and a StopSignal inhibition task in the second college year. At testing and at the end of the fourth college year, heavy alcohol use was assessed. Disadvantageous performance on the IGT was associated with higher scores on a heavy drinking measure and higher quantity/frequency of alcohol use 2 years past neurocognitive testing in male students even after controlling for prior drinking. These results were corrected for heavy drinking and alcohol use in the period before neurocognitive testing. Interactions with gender indicated that this general pattern held for male but not for female students. Level of response inhibition was not associated with either of the alcohol use measures prospectively. These findings indicate that a neurocognitive decision-making task is predictive of maladaptive alcohol use. Advantageous decision makers appear to show adaptive real-life decision making, changing their drinking habits to the changing challenges of early adulthood (e.g., finishing college), whereas disadvantageous decision makers do not, and continue to drink heavily. These findings extend earlier findings of neurocognitive predictors of relapse in clinical substance-dependent groups, to subclinical alcohol use and abus

Bridge Study

The present study examines the relationship between emotion regulation strategies, specifically cognitive reappraisal and emotion suppression, and substance use during pregnancy. The study also examines emotion regulation strategies' relationships with anxiety, depression, and trauma