Patient Expectancy as a Mediator of Placebo Effects in Antidepressant Clinical Trials

Published on Feb 1, 2017in American Journal of Psychiatry13.655
· DOI :10.1176/appi.ajp.2016.16020225
Bret R. Rutherford20
Estimated H-index: 20
Melanie M. Wall67
Estimated H-index: 67
+ 6 AuthorsSteven P. Roose52
Estimated H-index: 52
Objective:Causes of placebo effects in antidepressant trials have been inferred from observational studies and meta-analyses, but their mechanisms have not been directly established. The goal of this study was to examine in a prospective, randomized controlled trial whether patient expectancy mediates placebo effects in antidepressant studies.Method:Adult outpatients with major depressive disorder were randomly assigned to open or placebo-controlled citalopram treatment. Following measurement of pre- and postrandomization expectancy, participants were treated with citalopram or placebo for 8 weeks. Independent samples t tests determined whether patient expectancy differed between the open and placebo-controlled groups, and mixed-effects models assessed group effects on Hamilton Depression Rating Scale (HAM-D) scores over time while controlling for treatment assignment. Finally, mediation analyses tested whether between-group differences in patient expectancy mediated the group effect on HAM-D scores.Resul...
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