Am J Psychiatry 156:829-836, June 1999
© 1999 American Psychiatric Association
Placebos, Drug Effects, and Study Design: A Clinician's Guide
Frederic M. Quitkin, M.D.
OBJECTIVE: This article examines the role of placebos in evaluating the efficacy of psychiatric drugs. Also addressed are the identification of placebo effects on drugs, the relevance of active placebo, the need for placebo groups in psychotherapy studies, and ethical issues concerning the use of placebo. METHOD: Psychiatric drug treatment trials were reviewed. RESULTS: Emphasis was placed on studies with ambiguous outcomes, studies using an active placebo, and studies attempting to understand the role of placebo effects on patients receiving a drug. The concept of pattern analysis for identifying true drug effect is reviewed. Evidence that placebos are required to prevent a false conclusion about drug efficacy is presented. The public health implications of concluding that an ineffective drug is beneficial are examined. Active placebos do not appear necessary, and there is some evidence that the odds of identifying a patient who has improved as a result of true drug effect (as opposed to placebo effect) exceed chance with pattern analysis. CONCLUSIONS: Psychiatric disorders have a fluctuating course, psychiatry's phenomenologically based nosological system is inexact, and the interaction between these two leads to a large proportion of patients experiencing a placebo effect. It may be possible to identify patients receiving an antidepressant who improved as a result of a placebo effect. This is an educated guess that may be helpful in planning the treatment of patients who have a contraindication to continuing a psychopharmacological regimen.
This article has been cited by other articles:
|
|
|
|
 
T. Shibre, A. Alem, A. Abdulahi, M. Araya, T. Beyero, G. Medhin, N. Deyassa, A. Negash, A. Nigatu, D. Kebede, et al.
Trimethoprim as Adjuvant Treatment in Schizophrenia: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial
Schizophr Bull,
June 16, 2009;
(2009)
sbn191v2.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. T. Gaynor and A. Harris
Single-Participant Assessment of Treatment Mediators: Strategy Description and Examples From a Behavioral Activation Intervention for Depressed Adolescents
Behav Modif,
May 1, 2008;
32(3):
372 - 402.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. H. Dworkin, J. Katz, and M. J. Gitlin
Placebo response in clinical trials of depression and its implications for research on chronic neuropathic pain
Neurology,
December 29, 2005;
65(12_suppl_4):
S7 - S19.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. N. Osser, R. D. Patterson, and J. J. Levitt
Guidelines, Algorithms, and Evidence-Based Psychopharmacology Training for Psychiatric Residents
Acad Psychiatry,
June 1, 2005;
29(2):
180 - 186.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. N Jureidini, C. J Doecke, P. R Mansfield, M. M Haby, D. B Menkes, and A. L Tonkin
Efficacy and safety of antidepressants for children and adolescents
BMJ,
April 10, 2004;
328(7444):
879 - 883.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Parker, K. Roy, and K. Eyers
Cognitive Behavior Therapy for Depression? Choose Horses for Courses
Am J Psychiatry,
May 1, 2003;
160(5):
825 - 834.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. T. Walsh, S. N. Seidman, R. Sysko, and M. Gould
Placebo Response in Studies of Major Depression: Variable, Substantial, and Growing
JAMA,
April 10, 2002;
287(14):
1840 - 1847.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Charney, C. B. Nemeroff, L. Lewis, S. K. Laden, J. M. Gorman, E. M. Laska, M. Borenstein, C. L. Bowden, A. Caplan, G. J. Emslie, et al.
National Depressive and Manic-Depressive Association Consensus Statement on the Use of Placebo in Clinical Trials of Mood Disorders
Arch Gen Psychiatry,
March 1, 2002;
59(3):
262 - 270.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. F. Leuchter, I. A. Cook, E. A. Witte, M. Morgan, and M. Abrams
Changes in Brain Function of Depressed Subjects During Treatment With Placebo
Am J Psychiatry,
January 1, 2002;
159(1):
122 - 129.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. B. Oosterbaan, A. J. L. M. van Balkom, P. Spinhoven, and R. van Dyck
The placebo response in social phobia
J Psychopharmacol,
May 1, 2001;
15(3):
199 - 203.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. C. Shelton, M. B. Keller, A. Gelenberg, D. L. Dunner, R. Hirschfeld, M. E. Thase, J. Russell, R. B. Lydiard, P. Crits-Christoph, R. Gallop, et al.
Effectiveness of St John's Wort in Major Depression: A Randomized Controlled Trial
JAMA,
April 18, 2001;
285(15):
1978 - 1986.
[Abstract]
[Full Text]
[PDF]
|
|
|
Get information about faster international access.
Privacy Policy
Copyright © 1999
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
