On 30 Sep 2004, Allen Esterson wrote: > > I agree with Stephen that it would have been valuable to study the effects > of CBT with a placebo, but not when he writes says that giving CBT with a > sugar pill would be �without risk of adverse effects�. It may well be with > some severely depressed patients that there would be adverse effects of > not prescribing Prozac (or another SSRI), namely the continuation of > excruciating symptoms beyond what might have occurred had Prozac been > used. (It�s the nature of the situation that the discussion here deals > with hypotheticals.)
Allen's point [despite a disclaimer] does depend on the assumption that Prozac is more effective than placebo for depression. If true, then certainly withholding Prozac in favour of a sugar pill would lead to adverse effect. In the very recent TADS study of adolescents diagnosed with major depression I referred to in my previous post (March et al, 2004), Prozac alone was no more effective than placebo over the 12 weeks of treatment (although it was on "supportive contrasts on the week 12 adjusted means"). The effectiveness of SSRIs vs placebo is currently a contentious issue, notwithstanding the review cited by Allen of Donald Klein and his associates in favour of the drug. > On Stephen�s remark that �it raises the interesting question whether all > behaviour therapy would go better with a placebo pill�, it may well be a > good idea to include this component among the alternatives in many > studies. But it should be remembered that CBT is used for a number of > rather different mental disorders/illnesses. Would it be sensible to treat > someone with bipolar disorder, when suicide is a very real risk in the > depressive phase, with CBT plus a placebo when there is good evidence that > lithium is effective in controlling the symptoms? No, not when such evidence exists and when it is considered appropriate that the drug be prescribed. What I'm suggesting is that when a decision is made to treat someone with behaviour therapy alone (without a drug), it wouldn't hurt to tell the patient something like this: "I'm also going to ask a doctor to prescribe a pill for you which can sometimes be very helpful for people undergoing therapy. We don't really understand how it works but I can assure you that it's very safe and has no side effects." Then arrange for them to receive a placebo. Actually, I think we could use a good study on this issue, something which the TADS study could have done but didn't. (But as my wife pointed out, this wouldn't work for me. I'd want to know the name of the pill, and then research it on the web!) Stephen March, J. et al (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression, JAMA, 292, 807-- ___________________________________________________ Stephen L. Black, Ph.D. tel: (819) 822-9600 ext 2470 Department of Psychology fax: (819) 822-9661 Bishop's University e-mail: [EMAIL PROTECTED] Lennoxville, QC J1M 1Z7 Canada Dept web page at http://www.ubishops.ca/ccc/div/soc/psy TIPS discussion list for psychology teachers at http://faculty.frostburg.edu/psyc/southerly/tips/index.htm _______________________________________________ --- You are currently subscribed to tips as: [EMAIL PROTECTED] To unsubscribe send a blank email to [EMAIL PROTECTED]
