Public thresholds for antidepressant effectiveness and adverse drug reaction rates: a cross-sectional study.

The effectiveness of antidepressants (ADs) in the treatment of depression is continuously discussed regarding its clinical relevance. The objective of this study was to explore thresholds of members of the public for effectiveness of ADs relative to the frequency of adverse drug reactions (ADRs) deemed acceptable. We conducted a cross-sectional online survey in Germany that included individuals with and without experiences of depression and ADs. Participants were presented a case scenario describing a moderate depressive episode, operationalized with the Montgomery Åsberg Depression Rating Scale (MADRS). Participants were asked to rate the effectiveness of different treatment options, estimate the frequency of 15 ADRs, and indicate the minimal level of treatment effectiveness they would require to accept certain ADRs. The survey was completed by 208 participants (144 female, 64 male), 44 were taking ADs. The effectiveness of ADs was significantly overestimated (t(204) = 8.96, p < 0.001, d = 0.63). For 13 ADRs, participants selected package-insert frequency categories that were significantly lower than the corresponding reference categories. For example, to accept the potential ADR of seizures, participants required a symptom improvement of M = 23.51 (SD = 8.82) points on the MADRS. We propose that patient-physician communication about risks and benefits of AD treatment should explicitly address individual expectations.