Abstract
BackgroundMeta-analyses of placebo-controlled trials of SSRIs suggest that only a small portion of the observable change in depression may be attributed to "true" pharmacological effects. But depression is a multidimensional construct, so treatment effects may differ by symptom cluster. We tested the hypothesis that SSRIs uniquely alter psychological rather than somatic symptoms of depression and anxiety.MethodOutpatients with moderate to severe MDD were randomly assigned to receive paroxetine (n = 120) or placebo (n = 60).ResultsParoxetine significantly outperformed placebo on all psychological subscales of the syndrome measures, but not on any of the somatic subscales. The difference in score reduction between paroxetine and placebo was more than twice as great for the psychological symptoms compared to the somatic symptoms.ConclusionsParoxetine appears to have a “true” pharmacological effect on the psychological but not on the somatic symptoms of depression and anxiety. Paroxetine's influence on somatic symptoms appears to be mostly duplicated by placebo.
Highlights
Depression is a multi-faceted disorder encompassing emotional, cognitive, behavioral, and somatic symptoms
Paroxetine's influence on somatic symptoms appears to be mostly duplicated by placebo
The funders of the original clinical trial had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Summary
Depression is a multi-faceted disorder encompassing emotional, cognitive, behavioral, and somatic symptoms. Meta-analyses of placebo-controlled trials of most SSRIs estimate that placebo accounts for about 75% of the effects of ADM during the acute phase treatment [3, 4] That is, these data suggest that no more than 25% of the observable change may be attributed to the pharmacological effects of SSRIs, whereas the majority of change is due to nonspecific placebo effects and natural course of the illness (spontaneous remission). These data suggest that no more than 25% of the observable change may be attributed to the pharmacological effects of SSRIs, whereas the majority of change is due to nonspecific placebo effects and natural course of the illness (spontaneous remission) In this light, the psychopharmacological effects of SSRIs appear rather unimpressive. We tested the hypothesis that SSRIs uniquely alter psychological rather than somatic symptoms of depression and anxiety
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