A recent ‘meta-analysis’ of the placebo effect on the use of anti-depressants in children and adolescents (shudder …), based on data from trials involving more than 6,500 children and adolescents up to the age of 18, has been published by the University of Basel and Harvard Medical School and published in the journal ‘JAMA Psychiatry’.
The most common mental disorders in children and adolescents include anxiety disorders, depressive disorders, obsessive-compulsive disorder, and post-traumatic stress disorder.
“The results of the meta-analysis show that, although antidepressants work significantly better than placebos across the range of disorders, the difference is small and varies according to the type of mental disorder. However, the results also showed that the placebo effect played a significant role in the efficacy of antidepressants. The study also found that patients treated with antidepressants complained of greater side effects than those who received a placebo. The side effects included everything from mild symptoms such as headaches to suicidal behavior.”
‘Suicidal behaviour’ as a ‘side effect’ … Really?
Consistent with other posts through this blog, the analysis also shows that the placebo effect is stronger in cases of depression.
Although the clinical efficacy of antidepressants in children and adolescents is proven, it is frequently accompanied by side effects. In addition, the influence of the placebo effect on the efficacy of antidepressants is unclear. A meta-analysis of data from over 6,500 patients has now shown that, although antidepressants are more effective than placebos, the difference is minor and varies according to the type of mental disorder. The results were obtained by the University of Basel and Harvard Medical School and were published in the journal JAMA Psychiatry.
The results of the meta-analysis show that, although antidepressants work significantly better than placebos across the range of disorders, the difference is small and varies according to the type of mental disorder. However, the results also showed that the placebo effect played a significant role in the efficacy of antidepressants. The study also found that patients treated with antidepressants complained of greater side effects than those who received a placebo. The side effects included everything from mild symptoms such as headaches to suicidal behavior.
We note an interesting ‘counter narrative’ emerging – that is, scepticism about the commonly held view that drug treatments designed for mood disorders such as depression often engage the Placebo Effect. In this counter-narrative,
“Drug trials don’t show much in the way of classic placebo effects. The rise in placebo responses over the years is more likely due to the supportive factors in drug trials…and increasing problems with enrollment.”
The new finding—no upward trend in placebo responses—is unexpected and certain to be contested. Meanwhile, it stands as a rebuke to a popular narrative. By that account, drug effects had been hyped, expectations soared, and the inflated hopes were reflected in rising placebo response rates.”
This is fine, except the counter-narrative also resonates with challenges about the efficacy of conventional ‘gold-standard’ ‘blind’ ‘placebo controlled’ drug trials, where it has been shown that trials funded by drug companies (who by definition have a vested interest in their outcome) are 30% more likely to return ‘favourable’ results than trials which are not funded in this way. The ‘placebo effect’ might be the design and execution of the trial itself, not the actual function and efficacy of the placebo …!
‘VR Placebo interventions’ …! We do indeed live in a time of wonders. Research is being undertaken into the value of the emerging Virtual Reality technologies in treatment of mental illness. It’s early days, but the results so far are promising. Read more here.
“Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain. Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory. But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect. Some antidepressants increase serotonin levels, some decrease it, and some have no effect at all on serotonin. Nevertheless, they all show the same therapeutic benefit. Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect, due to the fact that most patients and doctors in clinical trials successfully break blind. The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.”
More on the continuing critique of widespread prescription of antidepressants here.
It’s bad news if you’re Icelandic or Australian. Over at I Fucking Love Science they point out that “the report only covered the pharmaceutical habits of “developed countries.” Also, the United States – the original “Prozac Nation” – did not feature in this particular set of data. Separate data has shown 10% of Americans are prescribed antidepressants, which would put them second on this graph. We should also note that this is per thousand people, not by the total number consumed.”
Placebo beats pill for all but most severely depressed, study shows.
“Antidepressants are little better than placebos except for in severely clinically depressed samples,” Johnson said. “The implication was that medical doctors are overprescribing antidepressants because most patients are not severely depressed.”
Sugar pills can lower depression in people, writes Nature World News.
A new study suggests that people who believe that medication will help them to fight depression are those more likely to respond to placebo or fake treatments – compared with those who are skeptical about pharmaceutical interventions.
The study, by researchers at the University of California, found that the ‘power of pill’ is real for some depression patients.
‘In short, if you think a pill is going to work, it probably will,’ Andrew Leuchter, the study’s first author and a professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior, said in a statement.
The study included 88 people, who were aged between 18 and 65 years.
All participants had been diagnosed with depression and were given eight weeks of treatment.
Of the 88 patients, 29 received placebo treatment as well as supportive care, 20 were given supportive care alone and 39 were given genuine medication and supportive care.
The study is published in the British Journal of Psychiatry.