The persistence of the placebo response in antidepressant clinical trials.
ABSTRACT Our objective was to assess the persistence of the placebo response during at least 12 weeks of continued placebo administration in depressed patients who have responded to 6-8 weeks of acute placebo treatment. We identified 8 placebo-controlled antidepressant trials with a total of 3,063 depressed patients in which, after acute phase placebo treatment, placebo was continued for more than 12 weeks. The number of patients entering the continuation phase and percentages relapsing during this phase were determined. Based on the total number of patients entering the continuation phase 79% of placebo responders remained well (did not meet relapse criteria) during this phase compared to 93% of antidepressant responders. Although significantly more patients on placebo than on antidepressants relapsed in the continuation phase, 4 out of 5 placebo responders stayed well. The widely held belief that the placebo response in depression is short-lived appears to be based largely on intuition and perhaps wishful thinking.
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ABSTRACT: Two different and seemingly competing views on the diagnosis of major depressive disorder (MDD) exist. The first is that the diagnosis conflates adaptive sadness reactions with pathological states of depressed mood and that MDD is overdiagnosed and overtreated. The second is that MDD is an underdiagnosed and undertreated disorder, and one that is best characterised by a severe, chronic, recurrent or treatment-resistant course. Existing research suggests that both views are valid and merit being integrated. Anywhere from 30 to 50% of individuals will meet criteria for MDD at some point in their life. About half of these episodes are of brief duration and unlikely to recur. However, a remaining half is either chronic or recurrent. Data on the outpatient diagnosis of depression support the view that depression is simultaneously underdiagnosed and undertreated as well as overdiagnosed and overtreated. About one-third of the patients who meet criteria for MDD and receive placebos experience clinically significant and long-lasting improvement. Many other patients, however, are unresponsive to one or multiple active treatments. Thus, the diagnosis of MDD likely applies to individuals who are experiencing either normal periods of sadness or single-episode afflictions that are mild, unlikely to recur, and are placebo responsive, as well as to individuals with more severe clinical profiles. More research is needed that can help ascertain what contextual or biopsychological variables help distinguish between individuals who may be experiencing adaptive states of negative affect and those who experience severe, chronic, recurrent or treatment-resistant depressions.Epidemiology and Psychiatric Sciences 06/2015; DOI:10.1017/S2045796015000542 · 3.36 Impact Factor
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ABSTRACT: Scientific medicine regards placebo prescription as a lack of treatment, a control condition required to validate new therapies. However, recent studies show that placebo treatments induce beneficial effects that are larger than those observed during spontaneous healing, especially regarding depression, anxiety and other mood disorders. Here we review this literature, including meta-analyses showing that, except for severely depressed patients, placebo treatments are as effective as antidepressants. Then, we review studies concerning the conditions that modulate the size of the placebo effect in depression. We emphasize studies showing that a neurobiological conception of depression, held either by patients or their physicians, impairs healing. These observations call for considering the placebo effect as resulting from an interpersonal relationship that should be interpreted in reference to the psychoanalytical concept of transference. During a placebo treatment, the patient exchanges the medical acknowledgement of his patient status for a temporary improvement of his symptoms, but his transference is not taken into account by his physician. Actually, psychodynamic and cognitive-behavioral psychotherapies induce lasting improvements compared to placebo or antidepressant treatments. According to our interpretation, when psychotherapists take care of patient transference, including its heavy emotive power, their patients become conscious of their unconscious repetitions stemming from childhood and are able to free themselves from them. We conclude by a few suggestions regarding the training of psychotherapists and the excessive medicalization of psychic distress.L &E cute volution Psychiatrique 04/2013; 78(2):327–340. DOI:10.1016/j.evopsy.2013.02.004 · 0.13 Impact Factor