Placebo response rates in antidepressant trials: a systematic review of published and unpublished double-blind randomised controlled studies.

Furukawa, Toshi A; Cipriani, Andrea; Atkinson, Lauren Z; Leucht, Stefan; Ogawa, Yusuke; Takeshima, Nozomi; Hayasaka, Yu; Chaimani, Anna; Salanti, Georgia (2016). Placebo response rates in antidepressant trials: a systematic review of published and unpublished double-blind randomised controlled studies. The Lancet. Psychiatry, 3(11), pp. 1059-1066. Elsevier 10.1016/S2215-0366(16)30307-8

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BACKGROUND Previous studies have shown that placebo response rates in antidepressant trials have been increasing since the 1970s. However, these studies have been based on outdated or limited datasets and have used inappropriate statistical methods. We did a systematic review of placebo-controlled randomised controlled trials of antidepressants to examine associations between placebo-response rates and study and patient characteristics. METHODS In this systematic review, we searched for published and unpublished double-blind randomised placebo-controlled trials of first-generation and second-generation antidepressants for acute treatment of major depression in adults (update: Jan 8, 2016). The log-transformed proportions of placebo response, defined as 50% or greater reduction in depression severity score from baseline, were meta-analytically synthesised for each year. We then looked for a structural break point in the secular changes in these characteristics through the years and examined the influence of the study year and other trial and patient characteristics on the response rates through meta-regression. FINDINGS We identified 252 placebo-controlled trials (26 324 patients on placebo) done between 1978 and 2015. There was a structural break in 1991, and since then, the average placebo response rates in antidepressant trials have remained constant in the range between 35% and 40% (relative risk [RR] 1·00, 95% CI 0·97-1·03, p=0·99, for every 5-year increase). The length of the study and the number of study centres were significant factors (RR 1·03, 95% CI 1·01-1·05 for 1 more week in trial length; 1·32, 1·11-1·57 for multicentre vs single-centre trials). INTERPRETATION Contrary to the widely held belief, the average placebo response rates in antidepressant trials have been stable for more than 25 years. This new evidence should have an effect on the interpretation of the scientific literature and the future of psychopharmacology, both from a clinical and methodological point of view. FUNDING Japan Society for Promotion of Science, Great Britain Sasakawa Foundation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Chaimani, Anna and Salanti, Georgia

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2215-0374

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

03 Nov 2016 11:31

Last Modified:

23 Oct 2019 14:20

Publisher DOI:

10.1016/S2215-0366(16)30307-8

PubMed ID:

27726982

BORIS DOI:

10.7892/boris.89840

URI:

https://boris.unibe.ch/id/eprint/89840

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