Posted by SLS on January 11, 2009, at 8:25:03
In reply to Re: pediatric antidepressant placebo response » SLS, posted by Larry Hoover on January 10, 2009, at 19:33:17
I think you hit the nail on the head. I feel that the magnitude of the placebo response is proportional to the percentage of subjects chosen that do not have true Major Depressive Disorder.
Additionally, I think that young people are more resilient as their brains are still plastic enough to change affective function as psychosocial stresses are relieved. These patients are still very proximal in time to the psychological/biological insults that produced depressive thinking in the first place. There hasn't yet been enough time for these young depressions to be kindled more permanently.
I guess what I am trying to say is that young people are more likely to feel better in reaction to the positive stimuli presented in the study, as well as the absence of the offending negative stimuli they had been exposed to.
I am so glad you found these papers. I hope they stir up closer study of the placebo response and the weaknesses in the design and/or execution of current and past studies. I believe these weaknesses foster the relatively high statistical values for placebo response.
For what it is worth:
As I have mentioned before, I was a research patient at the NIH for 9 months. As you could imagine, the depressions to be treated were more severe and resistant to previous treatments. The NIH also served a battery of psychometric examinations to verify that the diagnosis of affective disorder was correct. I was one of about 30 patients. I observed who was responding well to treatment, and who was not. Some of these people were there for well over a year. For those who responded, the difference in their outward appearance and behaviors were as amazing as the changes in their self-reported affect. I am convinced that these very few who managed to make it out of there well were responding to treatment. When blinds were broken, and these people were revealed their treatment, the ones that I learned about were all on active compounds. Several, actually. For most of us there, spontaneous remission was very unlikely, as the NIH also took into consideration the chronicity of illness in its subjects. They set out to learn how to treat the illness, not how to get drugs approved. I may have missed a few, but I would have to guess that the rate of placebo response - spontaneous remission - was just about nil. There was one person who responded dramatically to Xanax. Who knows what that was all about. She was one of the more severely ill people at the beginning. We all prayed that we were to be so lucky. We became a family. Everyone understood intimately the suffering of everyone else. After months of sharing the same pain, it became obvious that we were not placebo responders.
Patient selection is the most critical aspect of study design and execution when it comes to mental illnesses.
- Scott
poster:SLS
thread:873198
URL: http://www.dr-bob.org/babble/20090104/msgs/873312.html