The British Journal of Psychiatry (2007) 190: 287-292. doi: 10.1192/bjp.bp.106.028555
© 2007 The Royal College of Psychiatrists
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REVIEW ARTICLE

Therapeutic effect of follow-up assessments on antidepressant and placebo response rates in antidepressant efficacy trials

Meta-analysis

MICHAEL A. POSTERNAK, MD and MARK ZIMMERMAN, MD

Department of Psychiatry and Human Behaviour, Brown University School of Medicine, Rhode Island Hospital, Providence, RI 02905, USA

Correspondence: Dr Michael A. Posternak, Depression Clinical and Research Program, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 50 Staniford Street, Suite 4 01, Boston, MA 02114, USA. Email: mposternak{at}partners.org

Declaration of interest None.

Background It remains unclear how much various factors contribute to the placebo response.

Aims To estimate the therapeutic impact of follow-up assessments on placebo response in antidepressant trials.

Method Double-blind, placebo-controlled antidepressant trials that reported weekly changes in Hamilton Rating Scale for Depression (HRSD) scores over 6 weeks were selected. Included studies (n=41) were divided into those that conducted four, five or six follow-up assessments. Reductions in HRSD scores as a function of the different follow-up schedules were compared.

Results An extra follow-up visit at week 3 was associated with a 0.86 further reduction in HRSD score; an extra visit at week 5 was associated with a 0.67 further reduction. These effects represented approximately 34–44% of the placebo response that occurred over these time frames. Two additional visits were associated with twice the reduction in HRSD score than one, suggesting that the therapeutic impact of assessment visits is cumulative and proportional. A comparable therapeutic effect was also found in participants receiving active medication.

Conclusions Follow-up assessments in antidepressant treatment trials incur a significant therapeutic effect for participants on placebo, and this represents about 40% of the placebo response.


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