I think what is meant is a placebo with powerful side effects -- could the term "Powerful placebo" be eliminated or modified? I did a Google Scholar search for "powerful placebo" and "-Beecher" Beecher wrote an influential and much-cited article in the 50s called "The Powerful Placebo" and found a number of instances of its use - mostly in relation to acupuncture and psychoanalysis. This power comes from the subconscious mind.
View Large The pooled mean Mp was calculated by the following function: The effect size Cohen's d was calculated as the mean change divided by the standard deviation of the scale.
It can be calculated both as an absolute measure of an arm's efficacy or as the difference in the efficacy between arms. By reversing this function, one can calculate the standard deviation on the basis of available d and mean values.
The pooled standard deviation SDp was calculated by the following function: The pooled effect size as well as the pooled change in Hamilton Depression Rating Scale HAMD score was calculated by weighting by sample size and by the inverse of the variance, although some authors suggest these methods are essentially equal Friedrich et al.
All the calculations of the current study were based on table 1 of the original paper of Kirsch et al. We present all the data that derive from the current recalculation and do not make any effort to select the most important, in an effort to produce a transparent picture.
Results The main results and conclusions derived from the text of the Kirsch et al. The results from the recalculation of data are shown in Table 2. Table 2 Individual by trial and pooled baseline HAMD scores, sample sizes, standard deviations and raw improvement and effect sizes d, on the basis of table 1 by Are antidepressants an oxymoron et al.
Since the placebo change was similar in both analyses 7. This means that Kirsch et al. In contrast, all the effect sizes d reported by Kirsch et al. However, these authors failed to report that that the change in HAMD score was 3.
The plot of effect size d vs. However, the difference between drug and placebo remains stable over the years with regression lines being parallel.
Discussion Several papers in the literature criticize the conclusions of Kirsch et al. This is a convenient and practical way to prove a specific drug's efficacy, and does not necessarily demand an identical neurobiological mode of therapeutic action, although the theory behind this method suggests it.
In a further exploration of the early Gelfand's theory, response expectancy was found to be altered by previous experience, and even very small changes in the context of presentation can affect individual differences in the placebo response entire placebo situation Gelfand et al.
Essentially this model does not take into consideration the fact that placebo-arm patients receive additional treatment, usually with benzodiazepines, which strongly affect several HAMD items.
The hypothesis concerning depression is that there is a response which lies on a continuum from no intervention at all e. In order to confirm this theory, i. Research so far suggests that there may not be one placebo response but several, and there are multiple mechanisms involved and they may differ as a function of the context in which the placebo is presented.
Co-medication, usually with benzodiazepines, according to clinical needs is also responsible for a portion of the placebo response.
The meta-analysis of antidepressant trials comparing those with a run-in period to those without one suggests that this method does not increase drug—placebo differences Posternak et al. There are data suggesting that the proportion of patients that respond are indeed on a continuum e.
However, the model predicts that all augmented placebos should have similar efficacy and thus this theory does not explain why psychotherapy is inferior to pharmacotherapy Cuijpers et al. Kirsch seems to consider psychotherapy closer to active placebo, and antidepressants closer to augmented placebo, partially because of methodological issues concerning the ability to blind side-effects make patients realize that they are taking drug instead of placebo, and this increases their expectation Kirsch, a.
As a final need for the model to be considered as correct, it is necessary to prove that antidepressants are not significantly better than placebo and that there are no differences between antidepressants.
The supposed equal efficacy of all types of antidepressants i. SSRIs, tricyclics, monoamine oxidase inhibitors despite the fact that they have different modes of operation, the supposed similar efficacy of some active drugs that are not considered antidepressants amylobar bitone, lithium, liothyronine, and adinazolam and the high correlation between the placebo and the drug response support this thesis Kirsch,which implies a similar mechanism underlying the response no matter what the treatment intervention.
This is also partially supported by neuroimaging data Konarski et al. The final finding in support of Kirsch's theory was the results of his meta-analysis Kirsch et al.Antidepressant medication is the most commonly prescribed treatment for people with depression.
They are also commonly prescribed for other conditions, including bipolar depression, post-traumatic stress disorder, obsessive-compulsive disorder, chronic pain syndromes, substance abuse and anxiety and.
In a recent paper, Horder and colleagues (Horder et al., , J Psychopharmacol –) have suggested that the mainproblem in the Kirsch analysis is methodological. We argue that the results are similar irrespective of the method used. In our opinion the data suggest that placebo and drug effects are non-additive: antidepressants act independently of depression severity, while the.
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The following are some of the depression medications (antidepressants) available in the U.S. Antidepressants are supposed to work because nerve pain responds to your serotonin level, so any meds that push those up should work more or less. But it's a it of a broad approach. In other words though, the happier you are, the less pain you'll have ;-), though that can be an oxymoron from time to time.
What is a healthy weight for me? A few important tools can be used to determine if an individual is underweight, normal weight or overweight. The easiest tool is a Body Mass Index, which is calculated using height and weight to estimate levels of body fat.