Reader Response: Telephone-Based Cognitive Behavioral Therapy for Depression in Parkinson Disease: A Randomized Controlled Trial

摘要

Dobkin et al. deserve commendations for their well-designed trial in patients with depression and Parkinson disease showing telephone-based cognitive behavioral treatment improved by 7 points using the Hamilton Depression Rating Scale, over a 6-month follow-up. At first glance, this is good news: (1) industry-independent research is possible, and (2) the results are reliable, clinically relevant, and actionable in the real-life setting. Dobkin et al.’s trial contrasts with other trials in various conditions that promote antidepressants use. There are too many prescribers being misled by: (1) statistically significant—but, clinically irrelevant— improvements (2 points on the scale or 3 at best, meaning a Cohen’s d effect sizes of 0.4) in subjective symptoms on a scale with only 1/17 item measuring well-being2 and (2) a semblance of safety from a few-week follow-up in highly selected patients without polypharmacy. Among adverse effects too frequently overlooked is the withdrawal syndrome whose seriousness was denied by the UK Royal College of Psychiatrists until October 2019, despite a long crusade.