Mostly In The Mind( optimism that they will get better.It'...),Health

optimism that they will get better. It's a self-fulfilling prophecy." On the basis of this study and one that Wessely participated in (British Journal of Psychiatry, vol 172, p 227), he believes that the advantage antidepressants offer over placebos is just 15 to 20 per cent.

But a psychiatrist commentating on the new analysis in the latest issue of Prevention & Treatment is fiercely critical of the paper. Donald Klein of Columbia University, New York, who played a major role in developing antidepressant treatments, says the work is flawed because the group of trials chosen was "minuscule and unrepresentative" and amounted to "a failure of peer review".

Kirsch's and Sapirstein's work does not show that antidepressants have no pharmacological effect. However, Kirsch says the findings indicate "a pressing need for new methodologies in clinical trials" to discover the true extent of the placebo effect. One option might be to give some patients "active placebos" that cause side effects but have no medical effect.

The researchers' results also appear in the current issue of Prevention & Treatment, the American Psychological Association's electronic journal http://journals.apa.org/prevention/.

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Contact: Celia Thomas
claire.bowles@rbi.co.uk
44 171 331 2751
New Scientist
8-Jul-1998

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