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Related Experiment Videos

Antidepressants using active placebos.

J Moncrieff1, S Wessely, R Hardy

  • 1Psychiatry, Charing Cross Hospital, Gloucester House, 194, Hammersmith road, London, UK, W6 8BS. joannamoncrieff@compuserve.com

The Cochrane Database of Systematic Reviews
|June 19, 2001
PubMed
Summary
This summary is machine-generated.

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Antidepressant efficacy may be overestimated due to placebo effects. Active placebos, mimicking side effects, suggest smaller drug benefits than traditional trials indicate, warranting further research into unblinding.

Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • Antidepressants are considered effective for depression, but placebo effects are substantial.
  • Conventional trials using inert placebos may be biased by side effects revealing medication identity.
  • Active placebos, designed to mimic antidepressant side effects, can help mitigate this bias.

Purpose of the Study:

  • To investigate the efficacy of antidepressants when directly compared with active placebos.
  • To assess the impact of unblinding effects on antidepressant efficacy trials.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials comparing antidepressants with active placebos.
  • Searched MEDLINE, PsychLIT, and EMBASE databases up to July 2000.

Related Experiment Videos

  • Included nine studies with 751 participants; effect sizes were calculated and analyzed, including subgroup analysis for inpatient and outpatient trials.

    • Main Results:

    • Two studies showed statistically significant differences favoring antidepressants.
    • Pooled analysis of all nine studies yielded a small effect size (0.39 SD) favoring antidepressants.
    • Sensitivity analysis, excluding one highly positive trial, reduced the pooled effect size to 0.17 SD, indicating smaller differences.

    Conclusions:

    • Conservative estimates suggest small differences between antidepressants and active placebos.
    • Unblinding effects in trials using inert placebos may inflate perceived antidepressant efficacy.
    • Further research is needed to understand and address unblinding in clinical trials.