Placebo for depression: we need to improve the quality of scientific information but also reject too simplistic approaches or ideological nihilism

BMC Medicine

John R Geddes¹  Andrea Cipriani¹ 

[1] Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK

关键词: Publication bias;    Placebo;    Meta-analysis;    Major depressive disorder;    Antidepressants;   

Others  :  840791
DOI  :  10.1186/1741-7015-12-105

 received in 2014-05-23, accepted in 2014-05-23,  发布年份 2014

【 摘 要 】

The placebo response plays a major role in psychiatry, particularly in depression. A new network meta-analysis investigates whether the effects of placebo vary in studies comparing fluoxetine and venlafaxine, two widely prescribed antidepressants. Even though data from this article indicate that the effects of placebos do not differ, publication bias cannot be ruled out. The authors use their finding to criticise the paradigm of evidence-based medicine, questioning whether there is anything certain in psychiatry and, more precisely, in the field of antidepressant treatment for major depression. This study stimulates the debate about validity of scientific knowledge in medicine and highlights the importance of considering things from a different perspective. However, the authors’ view should be considered with caution. As clinicians, we make decisions every day, integrating individual clinical expertise and patients’ preferences and values with the best, up-to-date research data. The quality of scientific information must be improved, but we still think that valid conclusions to help clinical practice can be drawn from a critical and cautious use of the best available, if flawed, evidence.

Please see related articles: http://www.biomedcentral.com/1741-7015/11/230 webcite and http://www.biomedcentral.com/1741-7015/12/106 webcite.

【 授权许可】

   
2014 Cipriani and Geddes; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Finniss DG, Kaptchuk TJ, Miller F, Benedetti F: Biological, clinical, and ethical advances of placebo effects. Lancet 2010, 375:686-695.
• [2]Benedetti F: The placebo response: science versus ethics and the vulnerability of the patient. World Psychiatry 2012, 11:70-72.
• [3]Price DD, Finniss DG, Benedetti F: A comprehensive review of the placebo effect: recent advances and current thought. Annu Rev Psychol 2008, 59:565-590.
• [4]Moncrieff J: The antidepressant debate. Br J Psychiatry 2002, 180:193-194.
• [5]Gibbons RD, Hur K, Brown CH, Davis JM, Mann JJ: Benefits from antidepressants: synthesis of 6-week patient-level outcomes from double-blind placebo-controlled randomized trials of fluoxetine and venlafaxine. Arch Gen Psychiatry 2012, 69:572-579.
• [6]Walsh BT, Seidman SN, Sysko R, Gould M: Placebo response in studies of major depression: variable, substantial, and growing. JAMA 2002, 287:1840-1847.
• [7]Barbui C, Furukawa TA, Cipriani A: Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials. CMAJ 2008, 178:296-305.
• [8]Bridge JA, Birmaher B, Iyengar S, Barbe RP, Brent DA: Placebo response in randomized controlled trials of antidepressants for pediatric major depressive disorder. Am J Psychiatry 2009, 166:42-49.
• [9]Naudet F, Millet B, Charlier P, Reymann JM, Maria AS, Falissard B: Which placebo to cure depression? A thought-provoking network meta-analysis. BMC Med 2013, 11:230. BioMed Central Full Text
• [10]Cipriani A: Time to abandon evidence based medicine? Evid Based Ment Health 2013, 16:91-92.
• [11]National Institute for Health and Care Excellence: Depression: The Treatment and Management of Depression in Adults (Update). NICE Clinical Guideline 90. London: NICE; 2009. [http://www.nice.org.uk/CG90 webcite]
• [12]Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R, Watanabe N, Nakagawa A, Omori IM, McGuire H, Tansella M, Barbui C: Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 2009, 373:746-758.
• [13]Gartlehner G, Hansen RA, Morgan LC, Thaler K, Lux L, Van Noord M, Mager U, Thieda P, Gaynes BN, Wilkins T, Strobelberger M, Lloyd S, Reichenpfader U, Lohr KN: Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis. Ann Intern Med 2011, 155:772-785.
• [14]Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996, 312:71-72.
• [15]Eyding D, Lelgemann M, Grouven U, Härter M, Kromp M, Kaiser T, Kerekes MF, Gerken M, Wieseler B: Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials. BMJ 2010, 341:c4737.
• [16]Rutherford BR, Roose SP: A model of placebo response in antidepressant clinical trials. Am J Psychiatry 2013, 170:723-733.
• [17]Klein DF: The loss of serendipity in psychopharmacology. JAMA 2008, 299:1063-1065.
• [18]Nutt D, Goodwin G: ECNP Summit on the future of CNS drug research in Europe 2011: report prepared for ECNP by David Nutt and Guy Goodwin. Eur Neuropsychopharmacol 2011, 21:495-499.
• [19]Gispen-de Wied C, Stoyanova V, Yu Y, Isaac M, Pani L, de Andres-Trelles F: The placebo arm in clinical studies for treatment of psychiatric disorders: a regulatory dilemma. Eur Neuropsychopharmacol 2012, 22:804-811.
• [20]Kirsch I, Sapirstein G: Listening to Prozac but hearing placebo: a meta-analysis of antidepressant medication. Prev Treat 1998, 1:article 2a. doi:10.1037/1522-3736.1.1.12a
• [21]Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC: A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA 1992, 268:240-248.
• [22]Mello MM, Francer JK, Wilenzick M, Teden P, Bierer BE, Barnes M: Preparing for responsible sharing of clinical trial data. N Engl J Med 2013, 369:1651-1658.
• [23]Naudet F, Falissard B: Does Reductio ad absurdum have a place in evidence-based medicine? BMC Med 2014, 12:106.