How sound is the double-blind design for evaluating psychotropic drugs?

Sufficient data have accumulated to raise serious doubts about the integrity of the double-blind design that is presumed to shield psychotropic drug trials from bias and expectations. A major deficit in most drug trials has been the use of inert rather than active placebos. The deficiencies of the double-blind paradigm call for a questioning stance with respect to previous studies of psychotropic drug efficacy. Various possible ways of strengthening the double-blind paradigm are reviewed.