Posted by Larry Hoover on January 10, 2009, at 19:33:17
In reply to Re: pediatric antidepressant placebo response, posted by SLS on January 10, 2009, at 17:54:25
> > Editorial about the article, from same issue:
> >
> > http://ajp.psychiatryonline.org/cgi/content/full/166/1/1
>
> Charles Nemeroff, MD makes a valuable point when evaluating "placebo" responses. Treatment with placebo is not the same as "no treatment". Subjects are given supportive services and often find relief in knowing that they will be effectively treated. There are numerous other factors to be found in the handling of the subject that might effectively treat the psychological phenomena that are present.
>
> I guess I could write a whole lot more about the phenomenology and significance of the placebo response (and I have), but it seems like too large a project for me to take on right now.
>
>
> - ScottI like this quote from Dr. Arif Khan, from the April 2000 volume of Psychiatric Times:
"The less-than-impressive results in these and other studies also calls to mind the fact that patients assigned to placebo treatment in clinical trials are not "getting nothing." The capsule they receive is pharmacologically inert but hardly inert with respect to its symbolic value and its power as a conditioned stimulus. In addition, placebo-treated patients receive all of the commonly employed treatment techniques: a thorough evaluation; an explanation for their distress; an expert healer; a plausible treatment; expectation of improvement; a healer's commitment, enthusiasm and positive regard; and an opportunity to verbalize their distress. Jerome Frank, Ph.D., in his book Persuasion and Healing: A Comparative Study of Psychotherapy made a compelling case that these parts of treatment are the active ingredients of all the psychotherapies (1993)....
A cautionary note is indicated about the generalization of these data to the clinical management of depressed patients. The less-than-impressive difference between drug and placebo in this and other studies of clinical trials does not speak directly to the effectiveness of antidepressants in clinical practice. Participants in antidepressant clinical trials are a highly select group and are not representative of the general population of depressed patients. They are not actively suicidal, they are almost always outpatients who are moderately rather than severely or mildly depressed, and they are free of comorbid physical or psychiatric illness. They are likely to have a higher placebo response rate than more severely ill depressed patients.
Furthermore, the primary aim of these studies is not to assess the optimal effect of antidepressants, but rather to rapidly assess efficacy of new drugs so they can be brought to the market. Therefore, dose, duration and diagnosis in clinical trials are not necessarily ideally suited to identify the optimal effects of antidepressants. Accordingly, clinical trials may identify the lower bound of the effect size compared to placebo."
poster:Larry Hoover
thread:873198
URL: http://www.dr-bob.org/babble/20090104/msgs/873232.html