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Role of pill-taking, expectation and therapeutic alliance in the placebo response in clinical trials for major depression

机译:服用药,期望和治疗联盟在重大抑郁症临床试验的安慰剂反应中的作用

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Background Pill-taking, expectations and therapeutic alliance may account for much of the benefit of medication and placebo treatment for major depressive disorder (MDD). Aims To examine the effects of medication, placebo and supportive care on treatment outcome, and the relationships of expectations and therapeutic alliance to improvement. Method A total of 88 participants were randomised to 8 weeks of treatment with supportive care alone or combined with double-blind treatment with placebo or antidepressant medication. Expectations of medication effectiveness, general treatment effectiveness and therapeutic alliance were measured (trial registration at [ClinicalTrials.gov][1]: [NCT00200902][2]). Results Medication or placebo plus supportive care were not significantly different but had significantly better outcome than supportive care alone. Therapeutic alliance predicted response to medication and placebo; expectations of medication effectiveness at enrolment predicted only placebo response. Conclusions Pill treatment yielded better outcome than supportive care alone. Medication expectations uniquely predicted placebo treatment outcome and were formed by time of enrolment, suggesting that they were shaped by prior experiences outside the clinical trial. [1]: http://ClinicalTrials.gov [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00200902&atom=%2Fbjprcpsych%2F205%2F6%2F443.atom
机译:背景服药,期望和治疗联盟可能会为重度抑郁症(MDD)带来药物和安慰剂治疗的大部分好处。目的探讨药物,安慰剂和支持治疗对治疗效果的影响,以及期望和治疗联盟与改善之间的关系。方法共有88名参与者被随机分配到单独接受支持治疗或与安慰剂或抗抑郁药进行双盲治疗相结合的8周治疗。测量了对药物有效性,一般治疗有效性和治疗联盟的期望(在[ClinicalTrials.gov] [1]:[NCT00200902] [2]进行试验注册)。结果药物治疗或安慰剂加支持治疗没有显着差异,但结局明显优于单独的支持治疗。治疗联盟预测对药物和安慰剂的反应;入院时对药物有效性的期望仅预测安慰剂反应。结论丸剂治疗比单独的支持治疗产生更好的结果。药物期望值可以唯一地预测安慰剂治疗的效果,并由入组时间决定,这表明它们是由临床试验以外的以往经验所决定的。 [1]:http://ClinicalTrials.gov [2]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00200902&atom=%2Fbjprcpsych%2F205%2F6%2F443.atom

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