Posted by zazenducke on March 26, 2012, at 20:00:01
In reply to Re: new pdoc says there 'are no answers' » zazenducke, posted by SLS on March 26, 2012, at 9:44:45
> > > > Believing the placebo argument is spurious of course would enhance the chances that one would obtain a robust placebo response.
>
> What I meant to say is that the the high rate of placebo response evident in more recent investigations of major depressive disorder is used by some people to promulgate a thesis that antidepressants are ineffective. I believe this is a spurious argument.
>Now I understand what you are saying but I don't agree.
> > The placebo effect depends on the person who receives the placebo not realizing it is a placebo.
>
> I think the placebo effect depends upon the understanding that the assignment of placebo versus active treatment is randomized. Sometimes, an active placebo is used to fool people that they are being given the active treatment.DEFINITION The placebo effect is a positive therapeutic effect claimed by a patient after receiving a placebo believed by him to be an active drug. I was talking about individuals not studies.
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> > If you take a pill and believe the studies which show the relief afforded by this pill are caused by the placebo effect it cannot act as a placebo.
>
> Sorry. I don't understand what you are saying here.
>Again I am talking about individuals. If an individual takes a pill which he believes produces relief by placebo effect then he does not believe the pill is an active agent which is required by the definition.
> > > The placebo "response" rate decreases as the degree of severity of depression increases. What are your thoughts on this observation?
>
> Quite simply, I believe this means that the likelihood of selecting people who truly have the disease being investigated is greater. People who are eligible for the study will exhibit severe psychomotor retardation, cognitive impairments, slow thinking and speech, profound anergia, etc. These people are likely to have the MDD illness. People with less severe depressions will more often be representitive of conditions other than MDD and that are more responsive to psychosocial influences.
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> Frederick Quitkin noted in his studies that placebo responders will report feeling improved earlier, often in week 1, compared to active treatment. In addition placebo responders more often relapse early, often by week 4.
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> You synthesize very logical and insightful propositions. It might be instructive for you to have more facts to work with to refine those propositions. I think you will find that the issue is rather complex. It is somewhat difficult to find relevant investigations and articles that are objective in approach.
>
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> - ScottScott if you change the definition of MDD then the studies don't prove anything either way. They're irrelevant. The whole definition is so subjective. And then evaluating results with self reporting and checklists by clinicians based on their judgement with no objective tests or lab results etc etc
You may be right though.
Sorry I was unclear.
poster:zazenducke
thread:1013788
URL: http://www.dr-bob.org/babble/20120316/msgs/1014113.html