Abstract
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 and http://www.biomedcentral.com/1741-7015/12/106.
Highlights
The placebo effect has always been an intriguing topic in medicine, probably because of both its clinical implications and its philosophical correlates for the mind-body interaction [1]
The placebo effect has been explored across a variety of diseases and medical conditions but it is in psychiatry and most of all in depression - that the placebo response may play a major clinical role
For researchers Scientific interest is focusing on the influence of the placebo response on signal detection in clinical trials and what its physiologic mechanisms reveal about the pathophysiology of major depressive disorder [16]
Summary
The placebo effect has always been an intriguing topic in medicine, probably because of both its clinical implications and its philosophical correlates for the mind-body interaction [1]. As has been previously reported, venlafaxine is more efficacious than fluoxetine, but the funnel plots show some evidence of publication bias Emphasising this last point - and almost neglecting the primary finding of no difference between placebos - Naudet and colleagues argue that no one can be sure placebo really equals placebo in trials of major depressive disorder. The primary results from this study are consistent with evidence on antidepressants in moderate to severe acute major depression: some antidepressants are more effective than placebo [11] and material differences in efficacy exist between these drugs [12]. Even though the decisional process varies case by case and we may end up making a completely different choice, as clinical researchers this is the best information we can give to help patients and clinicians when an antidepressant is to be prescribed for a first episode of acute major depression
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