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Re: Placebo in depression SLS

Posted by Jane D on May 27, 2001, at 13:29:48

In reply to Re: NEJM Article says placebo effect small Jane D, posted by SLS on May 27, 2001, at 11:16:05

> Hi Jane.
> > > 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 find this observation to be reassuring. Other studies attacking the issue from other directions have concluded the same thing; that a placebo-control designed into study protocols is both valid and often necessary to produce meaningful results. Interestingly, one study concluded that there was little advantage to using an active placebo.
> I see now that I took unjustified liberties in my portrayal of point #4. I included it because of my personal experience when I first entered the NIMH research program and the statements made by members of the research staff there. They noted that a great proportion of their subjects evidenced a mildly brighter mood during the first two weeks, whereafter, their mood settled down to their original baseline. However, I made the mistake of assigning to their observations a causitive explanation. I recall that no statements were made to explain why or how this phenomenon occurred. I must also add that I am not aware of any study protocol developed to quantify or validate what they thought they witnessed anecdotally.

It may still turn out to be real. I found an editorial accompanying the article (which IS available online) after I made my first post. It points out some problems with the study. One I think was that these studies weren't designed to look for placebo effect and would miss small changes. I don't think we can ignore gut feeling even if we can't trust it either. I've experienced a temporary lift at the start of treatment too. How about the following scenario?

One symptom of depression is an irrational feeling of hopelessness about everything. Experiencing this and believing that it may never go away (which is not at all irrational) is also depressing in the less technical sense of the word. Depression causing situational depression? Starting a new treatment makes you believe again that there may be a cure so you can reason your way out of the rational part of your hopelessness. This makes you feel better even though the irrational part of the hopelessness remains until the depression is actively treated. Eventually, if the treatment fails, the rational hopelessness returns also.

This fits with the observation that placebo improvements are temporary and doesn't assume that they are unrelated to the placebo. I have no idea how this could be tested. Maybe it can't be.





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