Tagplacebo

Reading of the Week: Do Antidepressants Work? The New Cipriani Study

From the Editor

Last week, I spoke to a patient about antidepressants. “But do they really work?” she asked. While antidepressants are commonly prescribed, many patients wonder about them. That’s not surprising: in popular culture, these medications are often portrayed as risky and unhelpful. Just a few weeks ago, the most popular women’s fitness magazine in the world described fawningly how a woman quit her medications and felt better (“I felt more alive and in control of my emotions with each passing day”). A few years ago, a major study suggested that antidepressants basically match placebo in efficacy; 60 Minutes covered it.

And now there is the new Cipriani et al. paper. “We found that all antidepressants included in the meta-analysis were more efficacious than placebo in adults with major depressive disorder…”

Is this the biggest psychiatry paper of the year? Certainly, it may be one of the most impressive. It took six years of effort. Oxford University’s Andrea Cipriani and his co-authors drew from all available data – published and unpublished, and covering more than 500 trials.

The media coverage has been incredible. The Guardian summarized the paper with the first two words of its article: “Antidepressants work.”

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In this Reading, we look at the big study and mull the big implications.

DG

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Reading of the Week: Can a Fake Intervention Help Real Pain? Also, Preventing Depression

From the Editor 

“To a degree which has never been suspected, what powerful influence upon diseases is produced by mere imagination.” British physician John Haygarth wrote those words more than two centuries ago when considering the placebo effect.

Is it possible to successfully treat people with placebo in an open-label trial? That is, if people know they are taking placebo, will they still experience the benefit of placebo?

painCan a fake intervention help real pain?

In this week’s selection, we look at a new study where participants were offered placebo for back pain. Spoiler alert: it worked.

And, in a new feature for the Reading of the Week, we include an invited letter to the editor from Dr. Albert H. C. Wong who writes about the best way of preventing depression.

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Reading of the Week: Of Pills and Placebo – The Pecina et al. paper

High rates of placebo responses are consistently reported across medical conditions, notably mood disorders, Parkinson disease, and pain, but also schizophrenia, substance use disorders, and surgical procedures. Placebo response rates in antidepressant trials average 31% to 45% compared with approximately 50% responses to antidepressants, and they have increased over the last 30 years. The failure of antidepressant responses to separate from placebo has contributed to the reduction or discontinuation of research on new treatments for depression and other neuropsychiatric illnesses, hindering the development of novel neuropsychiatric treatments.

So begins a new paper considering the relationship between placebo and depression treatment.

This week’s Reading: “Association Between Placebo-Activated Neural Systems and Antidepressant Responses Neurochemistry of Placebo Effects in Major Depression” by Dr. Marta Peciña et al., which was just published “online first” by JAMA Psychiatry.

Dr. Marta Peciña

Here’s a quick summary: this is a big paper in a big journal that seeks to better understand the placebo effect and antidepressants, and taps neuroimaging to do so. There is, however, a catch: the number of patients involved is small. Continue reading