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Re: We need placebo ed_uk

Posted by SLS on July 30, 2005, at 20:50:13

In reply to Re: We need placebo SLS, posted by ed_uk on July 30, 2005, at 16:47:10

My idea was a quickie. It isn't something I've invested more than a few minutes thinking about. However, I think the way that we approach evaluating the efficacy of antidepressants must be viewed in the context of the high rate of placebo response. Perhaps our statistical methods can be refined to take the high placebo response into account. Perhaps it is as simple as adjusting our perspective and expectations. That an antidepressant is "only" 45% (30% placebo versus 75% active) better than placebo is a large number within the context of clinical trials of depression. Even if the percentage of active compound responders was as low as 60%, this would still represent a treatment superiority of 200% over placebo.

I would still want to look to do studies in which the inclusion criteria included only the more chronic and severe cases of depression. I bet the placebo response would be closer to 5-10%. What would happen if we included only those severe cases where cortisol levels were abnormal?

What are we treating? If 30% of those included in the study are primarily psychologically depressed rather than biologically, but still qualify under DMS IV criteria for major depressive disorder, how would we want to interpret a placebo response of 30%?


- Scott

 

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