Review: Benefi ts of antidepressants over placebo limited except in very severe depression
University of Hull, Hull, UK.Evidence-based mental health 05/2010; 13(2):49. DOI: 10.1136/ebmh.13.2.49
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- "placebo will reduce the hope induced compared to an open treatment. However, it has also been questioned whether typical trials on antidepressants are blinded properly, because usually inert placebos are used instead of active placebos, resulting in many patients who know to which condition they have been assigned   . If this is true, the effects of hope induction and expectancies in patients, clinicians and researchers should be larger in placebocontrolled trials with two active treatments compared to that with one because the chance to get an active treatment is larger. "
ABSTRACT: Randomized trials with antidepressants are often run under double blind placebo-controlled conditions, whereas those with psychotherapies are mostly unblinded. This can introduce bias in favor of psychotherapy when the treatments are directly compared. In this meta-analysis, we examine this potential source of bias. We searched Pubmed, PsycInfo, Embase and the Cochrane database (1966 to January 2014) by combining terms indicative of psychological treatment and depression, and limited to randomized trials. We included 35 trials (with 3721 patients) in which psychotherapy and pharmacotherapy for adult depression were directly compared with each other. We calculated effect sizes for each study indicating the difference between psychotherapy and pharmacotherapy at post-test. Then, we examined the difference between studies with a placebo condition and those without in moderator analyses. We did not find a significant difference between the studies with and those without a placebo condition. The studies in which a placebo condition was included indicated no significant difference between psychotherapy and pharmacotherapy (g=-0.07; NNT=25). Studies in which no placebo condition was included (and patients and clinicians in both conditions were not blinded), resulted in a small, but significant difference between psychotherapy and pharmacotherapy in favor of pharmacotherapy (g=-0.13; NNT=14). Studies comparing psychotherapy and pharmacotherapy in which both groups of patients (and therapists) are not blinded (no placebo condition is included) result in a very small, but significantly higher effect for pharmacotherapy. Copyright © 2015. Published by Elsevier Masson SAS.
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- "Besides their clinical use, placebo and its opposite nocebo effects are good examples of how mental activity may affect several physiological functions (Benedetti et al. 2011; Benedetti 2014; Pollo et al. 2011). For this reason, they have been studied with the aim to investigate their role in symptoms relief across a variety of conditions, such as pain, Parkinson's disease, and depression (Benedetti 2008, 2013; Frisaldi et al. 2013; Kirsch 2009, 2010). "
ABSTRACT: In this chapter we present and discuss recent studies on the mechanisms underlying placebo and nocebo effects in physical performance, showing how expectations and both pharmacological and nonpharmacological preconditioning procedures can be very effective in inducing placebo responses, with important implications for sport competitions. Furthermore, we place these findings within the biological model of central governor of fatigue, whose main goal is to protect our body from damage. A crucial aspect of this emerging field of placebo studies is related to the limit beyond which these procedures can be called doping in all respects.
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ABSTRACT: Application of Sustainability Principles to the Healthcare System The definition of sustainability appeared in 2006 at the UK Journal Nutrition Practitioner: "A complex system of interacting approaches to the restoration, management and optimization of human health that has an ecological base, that is environmentally, economically and socially viable indefinitely, that functions harmoniously both with the human body and the non-human environment, and which does not result in unfair or disproportionate impacts on any significant contributory element of the healthcare system." Generally, definitions of sustainability refer to those approaches that provide the best outcomes for both the human and natural environments, both now, and in the indefinite future. Sustainability is a robust concept that has proven its worth across a range of different industries including energy, agriculture, forestry and even construction and tourism. Contemporary healthcare in western countries is presently dominated by use of pharmaceutical drugs—and most indicators would suggest that these approaches have had very limited value in dealing with some of the greatest scourges facing human health, including chronic diseases, psychiatric diseases and even certain infectious diseases. The term should apply also to the conduct of medical practices, which should emphasize preventative healthcare in order to reduce the future burden on the healthcare sector, particularly by largely or partially preventable, chronic diseases such as heart disease, cancer, obesity, diabetes and osteoporosis, which currently represent the greatest burden.
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