Affordable Access

Publisher Website

Differential Placebo Responses for Pharmacotherapy and Neurostimulation in Late-Life Depression.

Authors
  • Wathra, Rafae A1
  • Mulsant, Benoit H1
  • Reynolds, Charles F 3rd2
  • Lenze, Eric J3
  • Karp, Jordan F4
  • Daskalakis, Zafiris J5
  • Blumberger, Daniel M6
  • 1 Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. , (Canada)
  • 2 Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
  • 3 Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
  • 4 Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, AZ, USA.
  • 5 Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
  • 6 Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected]. , (Canada)
Type
Published Article
Journal
Neuromodulation : journal of the International Neuromodulation Society
Publication Date
Dec 01, 2023
Volume
26
Issue
8
Pages
1585–1591
Identifiers
DOI: 10.1016/j.neurom.2021.10.019
PMID: 35088720
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The magnitude of the placebo response depends on both the modality used as the "placebo" and the intervention with which it is compared, both of which can complicate the interpretation of randomized controlled trials (RCTs) for depression in late life. Given that neurostimulation and pharmacotherapy are among the most common interventions studied for late-life depression, comparing the relative placebo responses in studies of these interventions can aid interpretation of relative effect sizes. We analyzed data from two RCTs of adults aged ≥60 years in an episode of treatment-resistant major depression, one comparing aripiprazole and matching placebo pills and the other comparing deep repetitive transcranial magnetic stimulation (rTMS) and sham rTMS. In both RCTs, depression was assessed using the 17-item Hamilton Depression Rating Scale (HDRS-17). The primary comparison occurred after four weeks using analysis of covariance (ANCOVA) of HDRS-17 scores in participants who received placebo pills or sham rTMS. Relevant covariates included years of education, duration of depressive episode, and baseline HDRS-17 score. Accounting for covariates, there was a larger reduction of HDRS-17 after four weeks in the sham rTMS group (estimated marginal mean ± SE: -5.90 ± 1.45; 95% CI: [-8.82, 2.98]) than in the placebo pills group (-1.07 ± 1.45; [-3.98, 1.85]). There were no significant differences between these groups in the binary outcome analysis of response and remission rates at four weeks or any outcome at trial end point comparison. Sham rTMS may have a larger placebo response than placebo pills early in the treatment of older adults with treatment-resistant depression. Differential placebo responses should be considered in both the interpretation and design of RCTs. Copyright © 2021 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.

Report this publication

Statistics

Seen <100 times