Placebo Effect Not Always Understood in Depression Treatments and Study
> 5/8/2006 9:24:31 AM

In a talk that she gave at this year's meeting of the Society for Neuroscience Dr. Helen Mayberg discussed the often misunderstood role of the placebo in depression treatments. Clinical Psychiatry News has a nice piece summing up Dr. Mayberg's comments and analyzing the difficulties that doctors and researchers have in parsing out the effect of a placebo in the study and execution of many depression treatments.

People tend to view placebo response as a nonspecific effect of treatment that occurs when people expect to feel better. And some may think patients who respond to placebo were not really sick in the first place. Such notions undermine the positive aspects of placebo response by increasing the stigma of mental illness, Dr. Mayberg said.

Dr. Mayberg, a professor at Emory University, has used meta-analysis of research literature as well as PET scanning technology to examine the reported and physiological responses to differing depression treatments and placebos. The trouble is that most people who undergo clinical trials, come in with a history of depression treatment, whether it is one of success or failure.

Researchers in antidepressant trials need to understand the expectations of the patients they are studying, Dr. Mayberg said. Currently, “there are relatively few first-episode, treatment-naive people who agree to be in a placebo-controlled, double-blind study of a new drug,” she said. “That's going to influence how we interpret what placebo responses are.”

Patients who are naive to a particular treatment or are having their first depressive episode may not know what recovery would be like and would have a very different expectation of what it means to be well than a patient with Parkinson's disease who knows from past experience what it is like to not have parkinsonian symptoms, she said.

By heeding Dr. Mayberg's advice and utilizing her research in the design and analysis of future depression research efforts, doctors and scientists should begin to see more rewarding results. This will also translate powerfully in the clinical world, where often depression treatments are not properly monitored or followed up upon.

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