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Open Access Highly Accessed Commentary

Placebo for depression: we need to improve the quality of scientific information but also reject too simplistic approaches or ideological nihilism

Andrea Cipriani* and John R Geddes

Author Affiliations

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK

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BMC Medicine 2014, 12:105  doi:10.1186/1741-7015-12-105

Published: 25 June 2014

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 webcite and http://www.biomedcentral.com/1741-7015/12/106 webcite.

Keywords:
Antidepressants; Major depressive disorder; Meta-analysis; Placebo; Publication bias