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Re: NEJM Article says placebo effect small SLS

Posted by Jane D on May 26, 2001, at 19:38:35

In reply to Re: NEJM Article says placebo effect small, posted by SLS on May 26, 2001, at 11:23:00

>It has always seemed to me that the placebo response rate of 30% reported for clinical trials of antidepressants was higher than I would expect intuitively given the way I personally experience depression and drug responses. Such a high response rate to placebo tends to make the active treatment seem less significant somehow.

Scott -

I've never been able to fit it into my experience either.

>Of great significance is the observation that the placebo response rate for the more severe or treatment-resistant depressions is very low; perhaps less than 10%.

>3. Depressions more often have a fluctuating or episodic course. Some of those people who improve during a trial of placebo would have done so anyway, as this was the natural course of their illness.

Those 2 points together make sense. In my own experience less depression means more fluctuation of mood. Also the way severe depression is defined is going to select for this. The more symptons you have most of the time for the last 2 weeks the higher you score on the rating scale. If your mood is fluctuating already you are probably going to meet that most of the time criteria for fewer items and by definition will be considered less severely depressed.

>4. A patient may experience great relief at the thought that they are receiving medical treatment that will end their pain.

This last is what the study challenged. They compared studies that had 3 groups, treatment, placebo and no treatment. This way any difference between the placebo and no treatment groups should be due to the patients belief in their treatment not random variation in the course of the illness. They found very little difference. Their conclusion is that placebo is justified in clinical trials but not as a treatment.

I've seen articles arguing that because of the supposed placebo effect it could be justifiable to lie to patients. So if you don't have a cure for something hand out a pill, promise it will work, and maybe the patient's belief will make something happen. I wonder how many ntidepressants are prescribed with that in mind and whether its different than for other types of drugs.

>5. One study I came across demonstrated that patients recruited through advertisements rather than consultation referrals tend to show a higher rate of early placebo response and are less depressed to start with. Many of the investigations published use recruits.

That's really interesting. I wonder why. The placebo article mentioned excluding studies with paid subjects. Maybe for the same reason?





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