The role of meta-analyses and umbrella reviews in assessing the harms of psychotropic medications: beyond qualitative synthesis

Epidemiology and Psychiatric Sciences
Marco SolmiJ P A Ioannidis

Abstract

ὠφελέειν, ἢ μὴ βλάπτειν (Primum non nocere) - Hιppocrates' principle should still guide daily medical prescribing. Therefore, assessing evidence of psychopharmacologic agents' safety and harms is essential. Randomised controlled trials (RCTs) and observational studies may provide complementary information about harms of psychopharmacologic medications from both experimental and real-world settings. It is considered that RCTs provide a better control of confounding variables, while observational studies provide evidence from larger samples, longer follow-ups, in more representative samples, which may be more reflective of real-life clinical scenarios. However, this may not always hold true. Moreover, in observational studies, safety data are poorly or inconsistently reported, precluding reliable quantitative synthesis in meta-analyses. Beyond individual studies, meta-analyses, which represent the highest level of 'evidence', can be misleading, redundant and of low methodological quality. Overlapping meta-analyses sometimes even reach different conclusions on the same topic. Meta-analyses should be assessed systematically. Descriptive reviews of reviews can be poorly informative. Conversely, 'umbrella reviews' can use a quantitat...Continue Reading

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Citations

Mar 11, 2019·European Journal of Epidemiology·Stefania Papatheodorou
Jul 18, 2019·Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Médicas E Biológicas·Wenwei BaiJianping Tao
May 3, 2019·Cancer Research and Treatment : Official Journal of Korean Cancer Association·Minkyo SongCharles S Rabkin
Nov 26, 2019·Epidemiology and Psychiatric Sciences·Corrado BarbuiGraham Thornicroft
Aug 28, 2020·The British Journal of Psychiatry : the Journal of Mental Science·Corrado BarbuiGraham Thornicroft
Oct 3, 2019·JAMA Psychiatry·Elena DragiotiEvangelos Evangelou
Nov 29, 2020·Neuroscience and Biobehavioral Reviews·Marco SolmiAndre F Carvalho
Jan 28, 2022·The British Journal of Psychiatry : the Journal of Mental Science·Chiara GastaldonGeorgios Schoretsanitis

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