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An Olfactory Preference Test for Measuring Olfactory Hedonic Biases in Mouse Models of Depression
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Antidepressant study design affects patient expectancy: a pilot study.

B Rutherford1, J Sneed, D Devanand

  • 1Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA. brr8@columbia.edu

Psychological Medicine
|September 8, 2009
PubMed
Summary
This summary is machine-generated.

Patient expectations for antidepressant medication effectiveness were higher when given active drugs versus placebo. This enhanced expectancy in the comparator group may explain better treatment response rates in clinical trials.

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • Response rates to antidepressant medications are higher in comparator-controlled trials than in placebo-controlled trials.
  • Patient expectancy is a significant factor influencing depression treatment outcomes.
  • This pilot study investigated the role of expectancy in placebo-controlled versus comparator treatment conditions for depression.

Purpose of the Study:

  • To compare patient expectancy of improvement between placebo-controlled and comparator treatment groups for major depressive disorder (MDD).
  • To determine if randomization to comparator antidepressant treatment leads to greater patient expectancy of improvement compared to placebo-controlled treatment.

Main Methods:

  • An 8-week randomized controlled trial (RCT) enrolled out-patients aged 18-65 with MDD.
  • Subjects were randomized to either placebo-controlled (escitalopram or placebo) or comparator (escitalopram or citalopram) antidepressant medication.
  • Patient expectancy of improvement was measured using the Credibility and Expectancy Scale (CES) before and after randomization.

Main Results:

  • Twenty subjects were enrolled with a mean age of 56.5 years and significant baseline depression scores (HAMD, BDI, CGI-Severity).
  • Randomization to the comparator group resulted in a significant and large effect size (1.5) for greater expected magnitude of improvement.
  • No significant group differences were observed in the expected likelihood of improvement.

Conclusions:

  • Antidepressant medication randomization to comparator groups significantly increased patients' expectancy of improvement magnitude compared to placebo-controlled groups.
  • These expectancy differences may account for the higher observed response and remission rates in comparator-controlled antidepressant trials.
  • Patient expectancy is a crucial element to consider in the design and interpretation of antidepressant clinical trials.