Role of the Placebo Response in the Treatment of Depressive Disorders
- 8 Downloads
Results from placebo-controlled trials of antidepressants have demonstrated that a large proportion of depressed patients show a significant improvement of symptoms while receiving placebo. In some patients, the improvement may be due to the natural course of the illness, independent of any therapeutic intervention, but in others it may be due to nonspecific therapeutic factors. Presumably, the latter are at least as relevant in clinical practice as in the research setting.
The factors responsible for the placebo effect are unknown. However, several clinical variables are associated with an improvement in depressed patients who receive placebo. The most consistent correlation is a negative one between the duration of the presenting episode and a diminished placebo response. In addition, the role of expectation or hope has been emphasised.
The placebo response appears to be less stable than the improvement attributable to drugs. In controlled antidepressant trials, a significant proportion of placebo responders will relapse during follow-up. Two patterns of placebo response have been identified; one is characterised by an early, abrupt, nonsustained improvement and the other by a gradual sustained response. The instability of the placebo response may explain why some patients lose an initial apparent antidepressant response.
It was recently proposed that the initial treatment for a sizeable proportion of depressed patients should be 4 to 6 weeks of placebo. This has been rejected on practical grounds. Although placebo treatment of depression cannot be fully advocated, knowledge of the determinants and course of the placebo response can be used to guide clinical management.
KeywordsPlacebo Depressed Patient Placebo Effect Placebo Treatment Placebo Response
Unable to display preview. Download preview PDF.
- 1.Brown WA. Placebo as a treatment for depression. Neuropsycho-pharmacology 1994; 10: 265–9Google Scholar
- 3.Horace B. English, Ava Champney English. A comprehensive dictionary of psychological and analytical terms. New York: Longmans Green, 1958Google Scholar
- 4.Shapiro AK, Shapiro E. The placebo effect: art or science? Med Times 1982; Jun: 45s-52sGoogle Scholar
- 5.Honigfeld G. Non-specific factors in treatment. I Review of placebo reactions and placebo reactors. Dis Nerv Sys 1964; 25: 145–56Google Scholar
- 6.Ross S, Buckelew LW. Placebo agentry: assessment of drug and placebo effects. In: White L, Tursky B, Schwartz GE, editors. Placebo theory, research, and mechanisms. New York: The Guildford Press, 1985: 67–82Google Scholar
- 7.Fisher S. Nonspecific factors as determinants of behavioral response to drugs. In: DiMascio A, Shader RI, editors. Clinical handbook of psychopharmacology. New York: Science House, 1970: 17–39Google Scholar
- 8.Grunbaum A. Explication and implications of the placebo concept. In: White L, Tursky B, Schwartz GE, editors. Placebo theory, research, and mechanisms. New York: The Guildford Press, 1985: 9–36Google Scholar
- 9.Hahn RA. A sociocultural model of illness and healing. In: White L, Tursky B, Schwartz GE, editors. Placebo theory, research, and mechanisms. New York: The Guildford Press, 1985: 167–95Google Scholar
- 11.Shapiro AK, Morris LA. The placebo effect in medical and psychological psychotherapies. In: Garfield SL, Bergin AE, editors. Handbook of psychotherapy and behavior change. New York: Wiley, 1978: 369–410Google Scholar
- 12.Frank JD, Frank JB. Persuasion and healing: a comparative study of psychotherapy. London: The Johns Hopkins University Press, 1991Google Scholar
- 13.Khan A, Dager S, Cohen S, et al. Chronicity of depressive episode in relation to antidepressant-placebo response. Neuro-psychopharmacology 1991; 4: 125–30Google Scholar
- 26.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. American Psychiatric Association, 1980Google Scholar
- 27.Klein DF. Identified placebo treatment?. Neuropsychopharma-cology 1994; 10: 271–2Google Scholar
- 28.Shrivastava RK, Schwimmer R, Brown WA, et al. DST predicts poor placebo response in depression [new research abstract no. 94]. Scientific Proceedings of the 138th meeting of the American Psychiatric Association; 1985 May 18–24: DallasGoogle Scholar
- 31.Peselow ED, Stanley M, Fieve RR. Plasma Cortisol and clinical response to antidepressants and placebo in depressed outpatients. Scientific Proceedings of the American College of Neuro-psychopharmacology; 1985 Dec 9–13: Maui, Hawaii, 124Google Scholar
- 36.Dunner DL. Commentary on ‘placebo as a treatment for depression’. Neuropsychopharmacology 1994; 10: 273–4Google Scholar
- 37.Rush AJ. Placebo responsiveness does not imply that placebo is sufficient treatment. Neuropsychopharmacology 1994; 10: 281–3Google Scholar