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Placebo eff ects in psychiatry: mediators and moderators
#MMPMID25815249
Weimer K
; Colloca L
; Enck P
Lancet Psychiatry
2015[Mar]; 2
(3
): 246-57
PMID25815249
show ga
A strong placebo response in psychiatric disorders has been noted for the past 50
years and various attempts have been made to identify predictors of it, by use of
meta-analyses of randomised controlled trials and laboratory studies. We reviewed
31 meta-analyses and systematic reviews of more than 500 randomised
placebo-controlled trials across psychiatry (depression, schizophrenia, mania,
attention-deficit hyperactivity disorder, autism, psychosis, binge-eating
disorder, and addiction) for factors identified to be associated with increased
placebo response. Of 20 factors discussed, only three were often linked to high
placebo responses: low baseline severity of symptoms, more recent trials, and
unbalanced randomisation (more patients randomly assigned to drug than placebo).
Randomised controlled trials in non-drug therapy have not added further
predictors, and laboratory studies with psychological, brain, and genetic
approaches have not been successful in identifying predictors of placebo
responses. This comprehensive Review suggests that predictors of the placebo
response are still to be discovered, the response probably has more than one
mediator, and that different and distinct moderators are probably what cause the
placebo response within psychiatry and beyond.
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