Comparing the evidential strength for psychotropic drugs: a Bayesian meta-analysis

Approval and prescription of psychotropic drugs should be informed by the strength of evidence for efficacy. Using a Bayesian framework, we examined (1) whether psychotropic drugs are supported by substantial evidence (at the time of approval by the Food and Drug Administration), and (2) whether there are systematic differences across drug groups. Data from short-term, placebo-controlled phase II/III clinical trials for 15 antipsychotics, 16 antidepressants for depression, nine antidepressants for anxiety, and 20 drugs for attention deficit hyperactivity disorder (ADHD) were extracted from FDA reviews. Bayesian model-averaged meta-analysis was performed and strength of evidence was quantified (i.e. BF(BMA)). Strength of evidence and trialling varied between drugs. Median evidential strength was extreme for ADHD medication (BF(BMA) = 1820.4), moderate for antipsychotics (BF(BMA) = 365.4), and considerably lower and more frequently classified as weak or moderate for antidepressants for depression (BF(BMA) = 94.2) and anxiety (BF(BMA) = 49.8). Varying median effect sizes (ES(schizophrenia) = 0.45, ES(depression) = 0.30, ES(anxiety) = 0.37, ES(ADHD) = 0.72), sample sizes (N(schizophrenia) = 324, N(depression) = 218, N(anxiety) = 254, N(ADHD) = 189.5), and numbers of trials (k(schizophrenia) = 3, k(depression) = 5.5, k(anxiety) = 3, k(ADHD) = 2) might account for differences. Although most drugs were supported by strong evidence at the time of approval, some only had moderate or ambiguous evidence. These results show the need for more systematic quantification and classification of statistical evidence for psychotropic drugs. Evidential strength should be communicated transparently and clearly towards clinical decision makers.