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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Larry Hoover on January 10, 2009, at 16:22:51
Interesting new study just published.
http://ajp.psychiatryonline.org/cgi/content/full/166/1/42
Lar
Posted by Larry Hoover on January 10, 2009, at 16:30:39
In reply to pediatric antidepressant placebo response, posted by Larry Hoover on January 10, 2009, at 16:22:51
Editorial about the article, from same issue:
Posted by SLS on January 10, 2009, at 17:54:25
In reply to Re: pediatric antidepressant placebo response, posted by Larry Hoover on January 10, 2009, at 16:30:39
> Editorial about the article, from same issue:
>
> http://ajp.psychiatryonline.org/cgi/content/full/166/1/1Charles 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.
- Scott
Posted by Larry Hoover on January 10, 2009, at 19:02:17
In reply to pediatric antidepressant placebo response, posted by Larry Hoover on January 10, 2009, at 16:22:51
> Interesting new study just published.
>
> http://ajp.psychiatryonline.org/cgi/content/full/166/1/42
>
> LarHmmm....that link worked when I tested it.
Try this one:
http://ajp.psychiatryonline.org/cgi/content/full/166/1/42?ijkey=ad0510f8e139f5348dd58a641a64a4d83ba3e259If that doesn't work, go to:
http://ajp.psychiatryonline.org/cgi/content/full/166/1/1
and select Reference 4, free full textLar
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."
Posted by desolationrower on January 11, 2009, at 1:59:49
In reply to Re: pediatric antidepressant placebo response » SLS, posted by Larry Hoover on January 10, 2009, at 19:33:17
> > > 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.
> >
> >
> > - Scott
>
> I 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."
>I saw that before and think its a valuable thing i'm glad you posted it. Along with bias from the industry, its part of why i trust models and animal research as much as these studies.
-d/r
Posted by linkadge on January 11, 2009, at 6:31:42
In reply to Re: pediatric antidepressant placebo response » SLS, posted by Larry Hoover on January 10, 2009, at 19:33:17
So then why don't we just become more loving and caring towards our sick children a society instead of giving kids heavy psychotropic substnaces - if in the end it is going to result in the same responce rate.
Linkadge
Posted by SLS on January 11, 2009, at 7:45:25
In reply to Re: pediatric antidepressant placebo response, posted by linkadge on January 11, 2009, at 6:31:42
> So then why don't we just become more loving and caring towards our sick children a society instead of giving kids heavy psychotropic substnaces - if in the end it is going to result in the same responce rate.
>
> Linkadge
Same?
- Scott
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
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