David O. Antonuccio

University of Nevada School of Medicine, Reno, Nevada, United States

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Publications (35)254.13 Total impact

  • Göran Högberg · David O Antonuccio · David Healy ·
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    ABSTRACT: Completed suicides are a major cause of death in adolescents in Sweden. Forensic analysis of completed suicides in children and adolescents shows there is one completed suicide per 1000 children taking a selective serotonin re-uptake inhibitor (SSRI). In order to elucidate these events we undertook a study of the results and reporting of suicidal events in the Treatment of Adolescents with Depression Study (TADS). We conclude that a major, albeit underreported, finding in the TADS was the significant increase of suicidal events in the adolescents on antidepressant medication in comparison to the group on placebo medication. The proportions of suicidal events were 11% and 2.7% respectively. This increased risk of suicidal events might be related to the high incidence of medication with an SSRI in the group of completed suicides among Swedish adolescents.
    The International journal of risk & safety in medicine 06/2015; 27(2):85-91. DOI:10.3233/JRS-150645
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    ABSTRACT: Medicating ADHD is a controversial subject that was acutely inflamed in 1995 when high rates of ADHD diagnosis and treatment were documented in southeastern Virginia. Psychologists in southeastern Virginia formed a regional school health coalition to implement and evaluate interventions to address the problem. Other professionals with strong ties to the pharmaceutical industry launched ad hominem attacks on the coalition's research and work. These attacks contributed to the work being terminated in 2005. In the ensuing years, ADHD drug treatment continued to escalate. Today, the national rate of ADHD diagnosis exceeds all reasonable estimates of the disorder's true prevalence, with 14 % of American children being diagnosed before reaching young adulthood. Notable key opinion leaders continue to claim that there is no cause for concern, but with a message shift from "the prevalence is not too high" to "high prevalence is not too concerning." This paper provides an object lesson about how innovative research can be derailed to the detriment of sound medical and mental health care of children when industry interests are threatened. Tenure may be the only option for protecting innovative research from specious attacks. The authors offer a summary of the data on ADHD drug treatments, suggest judicious use of such treatments, and add their voices to others who are once again sounding a cautionary alarm.
    Journal of Contemporary Psychotherapy 02/2014; 44(1):43-52. DOI:10.1007/s10879-013-9244-x
  • David Healy · Derelie Mangin · David Antonuccio ·
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    ABSTRACT: Randomized controlled trials (RCTs) are a useful tool to check the effectiveness of drugs but have come to shape the culture of medicine in a manner that increasingly compromises medical care. Dependence on RCT evidence is compromised by the well-known problems stemming non-publication of trials, lack of access to trial data, ghostwriting of those trials that are published and a variety of coding and other strategies to hide harms. But what is less appreciated is that whenever a drug and an illness can produce the same benefit or harm that the outcomes of RCTs can be profoundly misleading. This article gives examples of how RCTs can produce the wrong answer.
    The International journal of risk & safety in medicine 06/2013; 25(2):111-121. DOI:10.3233/JRS-130588
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    David Antonuccio · David Healy ·
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    ABSTRACT: This paper raises the question about whether the data on the medications we call antidepressants justify the label of antidepressant. The authors argue that a true antidepressant should be clearly superior to placebo, should offer a risk/benefit balance that exceeds that of alternative treatments, should not increase suicidality, should not increase anxiety and agitation, should not interfere with sexual functioning, and should not increase depression chronicity. Unfortunately, these medications appear to fall short on all of these dimensions. Many of the "side effects" of these medications have larger effect sizes than the antidepressant effect size. To call these medications antidepressants may make sense from a marketing standpoint but may be misleading from a scientific perspective. Consumers deserve a label that more accurately reflects the data on the largest effects and helps them understand the range of effects from these medications. In other words, it may make just as much sense to call these medications antiaphrodisiacs as antidepressants because the negative effects on libido and sexual functioning are so common. It can be argued that a misleading label may interfere with our commitment to informed consent. Therefore, it may be time to stop calling these medications antidepressants.
    06/2012; 2012:965908. DOI:10.6064/2012/965908
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    ABSTRACT: This study evaluated a treatment combining bupropion with a novel acceptance and relationship focused behavioral intervention based on the acceptance and relationship context (ARC) model. Three hundred and three smokers from a community sample were randomly assigned to bupropion, a widely used smoking cessation medication, or bupropion plus functional analytic psychotherapy (FAP) and acceptance and commitment therapy (ACT). Objective measures of smoking outcomes and self-report measures of acceptance and relationship processes were taken at pretreatment, posttreatment, 6-month, and 1-year follow-up. The combined treatment was significantly better than bupropion alone at 1-year follow-up with 7-day point prevalence quit rates of 31.6% in the combined condition versus 17.5% in the medication-alone condition. Acceptance and the therapeutic relationship at posttreatment statistically mediated 12-month outcomes. Bupropion outcomes were enhanced with an acceptance and relationship focused behavioral treatment.
    Behavior therapy 12/2011; 42(4):700-15. DOI:10.1016/j.beth.2011.03.002 · 3.69 Impact Factor
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    Barry L Duncan · David O Antonuccio ·
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    ABSTRACT: The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This article calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are often empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced based medicine’s inclusion of patient values as well as the movement toward health home and integrated care, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
    International Journal of Clinical Medicine 01/2011; 2(04):353-359. DOI:10.4236/ijcm.2011.24061
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    ABSTRACT: This study was designed to determine whether a physician-delivered bibliotherapy prescription would compare favorably with the prevailing usual care treatment for depression in primary care (that often involves medication) and potentially offer an alternative. Six family physicians were trained to write and deliver prescriptions for cognitive-behavioral bibliotherapy. Thirty-eight patients were randomly assigned to receive either usual care or a behavioral prescription to read the self-help book, Feeling Good (Burns, D. D. (1999). Feeling good: The new mood therapy. New York: HarperCollins). The treatment groups did not differ in terms of overall outcome variables. Patients in both treatment groups reported statistically significant decreases in depression symptoms, decreases in dysfunctional attitudes, and increases in quality of life. Although not statistically significant, the mean net medical expenses in the behavioral prescription group were substantially less. This study provided empirical evidence that a behavioral prescription for Feeling Good may be as effective as standard care, which commonly involves an antidepressant prescription.
    Journal of Clinical Psychology in Medical Settings 09/2010; 17(3):258-71. DOI:10.1007/s10880-010-9207-2 · 1.49 Impact Factor
  • Allan M. Leventhal · David O. Antonuccio ·
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    ABSTRACT: Over the past 30 years psychiatry has made a paradigm shift within a medical model from a psychological to a biological explanation for mental disorder. Depression is attributed to an imbalance of monoamines in the brain caused by depletion of neurotransmitters at receptor sites. The standard of care for treating depression is prescription of antidepressant medications alleged to correct this chemical imbalance. Research results testing the chemical imbalance theories for depression have been contradictory to the theories. Analyses of data from studies and meta-analyses of the efficacy of antidepressants indicate selective publication fostering an inflated impression of effectiveness and that antidepressants offer little more than placebos. Several sources of error, particularly breaking of the blind, may have determined outcome in studies showing drug/placebo differences. Despite negative results regarding the theory and pharmacotherapy for depression, the frequency of diagnoses of depression and prescription of antidepressant drugs have increased enormously. Economic interests more than science appear to be determining the treatment of depression. Prescription of antidepressant drugs as the standard of care for depression warrants reconsideration. A biopsychosocial model may be more useful than a disease model for conceptualizing and treating depression.
    Ethical human psychology and psychiatry 11/2009; 11(3):199-214. DOI:10.1891/1559-4343.11.3.199
  • Craig A. Yury · Jane E. Fisher · David O. Antonuccio · Marcia Valenstein · Jeremy Matuszak ·
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    ABSTRACT: Background: Treatment of depression with a single pharmaceutical agent often does not work, and several agents may be tried or combined to increase efficacy. Augmentation involves the addition of one or more medications to an existing antidepressant monotherapy to enhance mood and overall antidepressant response. Approximately 22% of individuals with unipolar depression are prescribed augmentation strategies. This study examined the effectiveness of augmentation strategies. Methods: A Medline search of studies published before January 1, 2007 was conducted to assess the extent of published data on the most frequently prescribed augmentation strategies. Studies with completed original data, sufficient efficacy data, and participants diagnosed with unipolar depression were included. Letters to the editor, preliminary data, data only presented at conferences, and small uncontrolled case reports were excluded. Results: 13 studies contained sufficient data to calculate an effect size. Mean estimated effect size of all 13 studies calculated with random effects was 0.1782 with a 95% confidence interval of −0.2513−0.6076. Conclusions: There are minimal published data examining antidepressant augmentation, and augmentation is a minimally effective treatment option.
    Ethical human psychology and psychiatry 11/2009; 11(3):171-182. DOI:10.1891/1559-4343.11.3.171
  • David Antonuccio · David Healy ·

    BMJ (online) 02/2009; 338:b1612. · 17.45 Impact Factor
  • David Antonuccio · David Healy ·
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    ABSTRACT: In a rapid response Leo and Lacasse critiqued a study published in JAMA for not mentioning that a psychosocial intervention was as effective as an antidepressant for post-stroke depression and for failing to record relevant conflicts of interest.1 JAMA’s editors have since contacted Leo and his superiors. …
    BMJ Clinical Research 12/2008; 338(7701). DOI:10.1136/bmj.b1612 · 14.09 Impact Factor
  • David Antonuccio ·
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    ABSTRACT: Since the FDA held hearings in February 2004 on the safety of antidepressants in children, there has been a great deal of controversy regarding the use of antidepressants in children, culminating in the well publicized black box warnings about increased risk of suicidal behavior in children and young adults (up to age 25) caused by these medications. Using questions that a parent might ask, the current article attempts to summarize the efficacy and safety data on the use of antidepressants in children so that psychologists, with or without prescription privileges, may be able to inform parents of young patients about the science behind this treatment. This article is based on a presentation at the 2007 American Psychological Association conference by the author in acceptance of the 2006 APAHC Bud Orgel Award for Distinguished Achievement in Research. Much of the information described in this article is drawn from the recent APA Report of the Working Group on Psychoactive Medications for Children and Adolescents. (Brown et al. 2006; available at www.apa.org/pi/cyf/childmeds.pdf ) culminating in a book by the same authors (Brown et al., Childhood mental health disorders: Evidence base and contextual factors for psychosocial, psychopharmacological, and combined interventions 2007).
    Journal of Clinical Psychology in Medical Settings 07/2008; 15(2):92-7. DOI:10.1007/s10880-008-9108-9 · 1.49 Impact Factor
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    David O Antonuccio · David Healy ·
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    ABSTRACT: Lenzer and Brownlee hit the nail on the head regarding the important issue of data access.1 We owe all human subjects who volunteer for behavioural and medical research more than they have been getting. For years, the top scientific journals have required that all clinical trials be publicly registered before data collection begins, in order to be eligible for publication. This was an important step designed to reduce publication bias, but it did not go far enough. …
    BMJ (online) 04/2008; 336(7645):629. DOI:10.1136/bmj.39520.521146.3A · 17.45 Impact Factor
  • Wendy S Pachter · Ronald E Fox · Philip Zimbardo · David O Antonuccio ·
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    ABSTRACT: A presidential task force on external funding was established by the American Psychological Association (APA) in 2003 to review APA policies, procedures, and practices regarding the acceptance of funding and support from private corporations for educational and training programs; continuing education offerings; research projects; publications; advertising; scientific and professional meetings and conferences; and consulting, practice, and advocacy relationships. This article, based on the Executive Summary of the APA Task Force on External Funding Final Report, presents the findings and unanimous recommendations of the task force in the areas of association income, annual convention, research and journals, continuing education, education, practice, and conflicts of interest and ethics. The task force concluded that it is important for both APA and individual psychologists to become familiar with the challenges that corporate funding can pose to their integrity. The nature and extent of those challenges led the task force to recommend that APA develop explicit policies, educational materials, and continuing education programs to preserve the independence of psychological science, practice, and education.
    American Psychologist 01/2008; 62(9):1005-15. DOI:10.1037/0003-066X.62.9.1005 · 6.87 Impact Factor
  • David O. Antonuccio · Amber Hayes ·
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    ABSTRACT: Behavioral principles are powerful predictors of human behavior. When health care professionals understand these principles, they can be applied to changing health behaviors. In this chapter, we review the principles, which many of the readers will be familiar with from undergraduate and graduate classes. We apply the principles to PBL cases to illustrate behavioral principles in medical care. At the end of this chapter, the reader will be able to 1. Define the important behavioral terms such as classical conditioning, operant conditioning, reinforcement, reward, punishment, reinforcement schedule, antecedents, consequences, stimulus control, modeling, and functional analysis 2. Apply behavioral principles to some common behavioral problems observed in medicine 3. Develop treatment plans for some common behavioral problems using behavioral principals
    12/2007: pages 49-65;
  • David Antonuccio ·

    Ethical human psychology and psychiatry 11/2007; 9(3):147-151. DOI:10.1891/152315007782792678
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    ABSTRACT: Depression is a prevalent and expensive condition. Many patients are seeking and receiving treatment for depression in the primary care setting where pharmaceutical interventions prevail as the predominant treatment. While psychotropic medications can certainly help ameliorate mental and behavioral problems, all medical interventions carry with them certain risks and side effects. A natural multiple-baseline (across participants), single-case experimental design was used in a pilot study to evaluate the feasibility of “behavioral prescriptions” for cognitive-behavioral bibliotherapy with five depressed patients in a primary care setting. Results indicated that final depression self-report scores were lower than baseline and pre-treatment reports for every participant. At three month follow-up, three out of five participants reported no symptoms of depression, one participant reported minimal symptoms of depression, and one participant reported mild symptoms of depression. Behavioral prescriptions for cognitive bibliotherapy warrant further controlled research and may offer a cost-effective and practical treatment alternative to the pharmaceutical intervention of depression in primary care.
    Journal of Clinical Psychology in Medical Settings 08/2007; 14(2):152-159. DOI:10.1007/s10880-007-9064-9 · 1.49 Impact Factor
  • David O. Antonuccio · Jarrod M. Mosier ·

    Practitioner’s Guide to Evidence-Based Psychotherapy, 11/2006: pages 660-667;
  • David Antonuccio · David Burns ·

    JAMA The Journal of the American Medical Association 01/2005; 292(21):2577; author reply 2578-9. DOI:10.1001/jama.292.21.2577-a · 35.29 Impact Factor
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    ABSTRACT: This pilot study applied a theoretically derived model of acceptance-based treatment process to smoking cessation, and compared it to a pharmacological treatment based on a medical dependence model. Seventy-six nicotine-dependent smokers were randomly assigned to one of two treatments: Nicotine Replacement Treatment (NRT), or a smoking-focused version of Acceptance and Commitment Therapy (ACT). There were no differences between conditions at posttreatment; however, participants in the ACT condition had better long-term smoking outcomes at 1-year follow-up. As predicted by the acceptance process model, ACT outcomes at 1 year were mediated by improvements in acceptance-related skills. Withdrawal symptoms and negative affect neither differed between conditions nor predicted outcomes. Results were consistent with the functional acceptance-based treatment model.
    Behavior Therapy 09/2004; 35(4-35):689-705. DOI:10.1016/S0005-7894(04)80015-7 · 3.69 Impact Factor

Publication Stats

1k Citations
254.13 Total Impact Points


  • 1995-2015
    • University of Nevada School of Medicine
      Reno, Nevada, United States
  • 2014
    • University of Nevada, Las Vegas
      Las Vegas, Nevada, United States
  • 1995-2013
    • University of Nevada, Reno
      • • Department of Psychiatry
      • • School of Medicine
      Reno, Nevada, United States
  • 2012
    • Fielding Graduate University
      • School of Psychology
      Santa Barbara, California, United States
  • 2008
    • Cardiff University
      • Department of Psychological Medicine and Neurology
      Cardiff, Wales, United Kingdom
  • 2005-2008
    • Stanford University
      Palo Alto, California, United States