• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Chronic Disease

Placebo effect size in treatment-resistant depression in adults

byMeagan WiedermanandMichael Pratte
September 30, 2021
in Chronic Disease, Psychiatry, Public Health
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. In this systematic review and meta-analysis, pooled analysis of placebos for treatment-resistant depression demonstrated a large effect size, but no significant difference between placebo modalities.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Randomized controlled trials (RCTs) compare a drug’s efficacy to a placebo to isolate the effect of the drug above the psychological response to the belief of receiving treatment. In non-treatment-resistant depression (non-TRD), placebos have been shown to have a large effect that varies with the time of the investigation. No studies have yet quantified the magnitude of the placebo response in treatment-resistant depression (TRD) medication trials. This systematic review and meta-analysis quantified the placebo effect for different TRD treatments. The effect size was averaged as Hedges g for the placebo arms of 50 RCTs treating over 3000 TRD patients. The studies were assessed for bias. Subgroup analysis compared demographic, methodological, outcome and placebo type and duration data. The average effect of placebos was g = 1.05 and was similar for most placebo types. Further analysis of the funnel plot suggested some missing data that adjusted the effect size to g = 1.14. When removing the 19 high-risk of bias studies and only analyzing the 16 low-risk of bias RCTs, the g remained similar at 1.18. About 20% of patients responded to placebo and 13% went into remission. Furthermore, different modalities of placebo treatment did not differ significantly in response and remission rates. Sponsorship by industry, recent publication year, and open-label prospective treatment were associated with larger placebo effects, while numerous prior intervention failures was associated with a smaller placebo effect. A major concern of this meta-analysis was the heterogeneous classification of TRD by the included studies, causing exclusion of some large studies with more liberal TRD classification. One limitation of this study was the lack of psychotherapy and sham electroconvulsive therapy or magnetic seizure therapy placebos that might have met these inclusion criteria or have been conducted. A final limitation of this meta-analysis is that placebo groups occurred across many studies so none can be directly compared.

Click to read the study in JAMA Network Open

Click to read an accompanying editorial in JAMA Network Open

Relevant Reading: Randomized Placebo-Controlled Placebo Trial to Determine the Placebo Effect Size

In-Depth [systematic review and meta-analysis]: RCTs of treatment-resistant unipolar depression with at least 1 placebo (inert pill placebo, parenteral placebo, sham device, or sham therapy) arm and a pharmacologic or somatic treatment arm were included. Waitlist or usual therapeutic treatment placebos were excluded. Data on demographics (age and sex, past depression history and response to therapy), methodology (augmentation vs monotherapy, number of centers, length of study, number of treatment arms, design, year of publication, and sponsorship, sample size), outcomes (mean depression rating, response vs remitting), and placebo characteristics (route, number of days of treatment). The quality of each included study was assessed. The effect of the placebo was estimated with Hedges g. 50 of the 11236 screened studies were included (N = 3228, 45.8±6.0 years, 54.8% women). Placebos had a pooled effect size of g = 1.05 (95%CI =0.91-1.18, I2 = 76.19%). The effect sizes were averaged for the pill placebo (g = 1.14, 95%CI = 0.99-1.30; I2 = 80.25%), parenteral placebo (g = 1.33, 95%CI = 0.63-2.04, I2 = 62.28%), liquid placebo (g = 0.45, 95%CI = −0.26-1.15; I2 = 0%), repetitive transcranial magnetic stimulation (g = 0.89, 95%CI = 0.63-1.15, I2 = 62.14%), transcranial direct current stimulation (g = 1.32, 95%CI = 0.53-2.11, I2 = 52.57%), and invasive brain stimulation (g = 0.86, 95%CI = 0.58-1.14, I2 = 15.48%). The funnel plot of the effect was symmetric (Egger test: z = 1.18; P = 0.23), but was asymmetric on deep analysis, suggesting 5 unpublished studies that when considered made the effect size g = 1.14 (95% CI = 1.00-1.29). 16 RCTs were at low risk of bias, while 16 were at high risk; when considering only the low risk of bias studies the effect size was similar (g = 1.18, 95%CI = 0.98-1.38). For the 42 studies reporting response rates and 25 reporting remission, they were 21.2±14.6% and 13.0±9.05%, respectively. Industry-sponsored (β = 0.34, 95%CI = 0.09-0.59; P = 0.007), recently published (β = 0.03, 95%CI = 0.003-0.05, P = 0.03), and open-label prospective treatment phase before randomization (β = 0.35, 95%CI = 0.11-0.59, P = 0.004) had larger placebo effects. Numerous failed interventions during the current depressive episode had a smaller placebo effect (β = −0.12, 95%CI = −0.23-−0.01, P = 0.03).

RELATED REPORTS

Exercise improves symptoms in adults with depression

Wellness Check: Exercise

Youth depression and anxiety rates increased during the COVID-19 pandemic

Image: PD

©2021 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: depressionMajor Depressionplacebo
Previous Post

Contact aspiration with stent retrieval no more effective than stent retrieval alone for thrombectomy revascularization in stroke patients

Next Post

BMW May Have Canceled Its Hybrid Supercar Because of Covid-19

RelatedReports

Parents often unaware of adolescents’ suicidal thoughts
Lifestyle

Exercise improves symptoms in adults with depression

March 13, 2023
Adolescents’ muscle strength associated with lower cardiometabolic risk
Wellness

Wellness Check: Exercise

March 9, 2023
Association of Use of Oral Contraceptives With Depressive Symptoms Among Adolescents and Young Women
Pediatrics

Youth depression and anxiety rates increased during the COVID-19 pandemic

February 17, 2023
Quick Take: Effect of Developmentally Adapted Cognitive Processing Therapy for Youth With Symptoms of Posttraumatic Stress Disorder After Childhood Sexual and Physical Abuse
Wellness

Wellness Check: Mental Health

February 16, 2023
Next Post

BMW May Have Canceled Its Hybrid Supercar Because of Covid-19

#VisualAbstract The PERFORMUS trial: Sirolimus therapy shows efficacy in treating slow-flow malformations in children

#VisualAbstract The PERFORMUS trial: Sirolimus therapy shows efficacy in treating slow-flow malformations in children

10 Ways To Stay Productive At Home During Quarantine

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Transcarotid artery revascularization not associated with a significant difference in 30-day risk of stroke, death and myocardial infarction compared to carotid endarterectomy
  • Drinking characteristics in adolescence predict alcohol behaviors in early adulthood
  • Sodium-glucose co-transporter-2 inhibitors may decrease risk of in-stent thrombosis
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

Want more physician-written
medical news?

Join over 10 million yearly readers and numerous companies. For healthcare professionals
and the public.

Subscribe for free today!

Subscription options