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Study Fails To Find Differences In Therapy, Meds, Placebo
01-03-2012, 12:31 PM
Post: #1
Study Fails To Find Differences In Therapy, Meds, Placebo
SOURCE
http://www.forbes.com/sites/toddessig/20...ebo/print/

Hopeful News For Treating Depression: Study Fails To Find Differences In Therapy, Meds, Placebo

I expected the worst this morning: a subject line of “Uh oh” on a professional listserv posting from a respected colleague. Seems there’s a new study in the Journal of Clinical Psychiatry, one that failed to show any difference between anti-depressant medication, psychotherapy, and placebo in treating depression. This is the kind of “failed trial” drug companies tend not to publicize nor include in FDA approvals, and that can make clinicians really nervous about what we are doing. But rather than calling for anxious Subject lines, I think what this research does is once again demonstrate the power, and limitations, of hope; it illustrates how hope is an active ingredient in treating mild to moderate depression.

The study took a group of depressed patients and assigned them randomly to one of three treatment conditions: medication, psychotherapy, or placebo. Pretty standard clinical research. But this study has one unique feature requiring comment,

(u)nlike most efficacy trials, our sample comprised economically disadvantaged, highly comorbid, chronic, recurrently depressed, urban patients.

via Barber JP, Barrett MS, Gallop R, Rynn MA, Rickels K. Short-term dynamic psychotherapy versus pharmacotherapy for major depressive disorder: a randomized, placebo-controlled trial. J Clin Psychiatry. 2011 Nov 29. [Epub ahead of print]


In other words, they started with a unique group of people, at least from the perspective of previous research. Clinicians know, but research has tended to forget, that patients are all individual people with unique histories and rich lives. As a Reuters piece about this research states, “different people may respond differently to a given type of depression therapy. Barber’s team found some evidence of that.”

Statistically controlling for unique individual characteristics, as is frequently done in efficacy trials, doesn’t mean those factors are not important. It just means they are not influencing the outcome measure being used. Nevertheless, even the research team was surprised by the findings. But maybe we should stop being surprised by surprising findings, maybe even expect them as research gets more complex and moves beyond how to treat a disease or diagnosis to how to treat unique individuals, when it begins to unravel the clinical mystery of how to help this particular patient with this range of problems and symptoms.

So what does this study teach? Sometimes hope comes from a medication making subtle, or maybe not so subtle, changes to someone’s neurochemistry; sometimes from expecting a pill to work; and sometimes from a chance to talk about feelings and experiences with someone who listens and understands. That’s actually pretty good news.

But whether hope springs from a pill, the promise in a pill, or psychotherapy, none of them can lift the ceiling on well-being imposed by economics, other illnesses and problems, or a biography that has known more than a fair share of problems. Sadly, the tools of psychology and psychiatry are often poorly adapted to heal the damage of ongoing socio-economic problems.
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