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Meta-Analysis of Placebo Response in Adult Antidepressant Trials

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Abstract

Background

Roughly 80% of the symptom improvement experienced on antidepressants in clinical trials is also observed in the placebo comparison group. Understanding the correlates of placebo improvement and response is important to designing efficient and successful trials of future antidepressants.

Objective

The objective of this meta-analysis was to investigate the magnitude of placebo symptom improvement and placebo response rates in second-generation antidepressant trials of depression, anxiety, and obsessive-compulsive disorder.

Methods

We searched PubMed on 10 June, 2016, with no date or language limits, to identify randomized placebo-controlled trials of second-generation antidepressants in adults with depression, anxiety, or obsessive-compulsive disorder. We used a random-effects meta-analysis to examine the magnitude of placebo symptom improvement using standardized mean difference and placebo response rate. Stratified subgroup analysis and meta-regression were utilized to examine the effect of diagnostic indication and correlates of placebo symptom improvement.

Results

The meta-analysis included 164 trials involving 19,591 participants. Magnitude of placebo improvement and placebo response rates varied significantly between diagnostic indications. The magnitude of placebo improvement was much lower in obsessive-compulsive disorder (standardized mean difference = 0.58, 95% confidence interval 0.36–0.79) than in depression (standardized mean difference = 1.22, 95% confidence interval 1.12–1.32) or anxiety (standardized mean difference = 1.01, 95% confidence interval 0.90–1.12) trials. There was a large amount of heterogeneity in placebo improvement between studies (Q = 899,df = 110,p < 0.001,I2 = 88%). A greater number of study sites and a later publication year were associated with a greater magnitude of placebo improvement and response rate. Presence of a placebo lead-in and absence of non-US sites were associated with a reduced magnitude of placebo improvement. Trial duration was positively associated with the magnitude of placebo improvement in depression trials but negatively associated with the magnitude of placebo improvement in anxiety and obsessive-compulsive disorder trials.

Conclusions

Magnitude of placebo symptom improvement differed significantly based on diagnostic indication with improvement being significantly less in obsessive-compulsive disorder than anxiety and depression. Some trial characteristics were associated with a greater magnitude of placebo improvement in trials across disorders but others were disorder specific.

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Acknowledgements

The authors are grateful to Chad Beyer and Kiley Cappetta for their assistance in the study selection and data extraction.

Author information

Authors and Affiliations

  1. Yale Child Study Center, Yale University School of Medicine, 230 S. Frontage Road, New Haven, CT, 06520, USA

    Fenghua Li, Madeeha Nasir, Baris Olten & Michael H. Bloch

  2. Key Lab of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 211 South Block, 16 Lincui Road, Chaoyang District, Beijing, 100101, People’s Republic of China

    Fenghua Li

  3. Yale Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Michael H. Bloch

Authors
  1. Fenghua Li
  2. Madeeha Nasir
  3. Baris Olten
  4. Michael H. Bloch

Corresponding author

Correspondence toMichael H. Bloch.

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Funding

No sources of funding were received for the preparation of this article.

Conflict of interest

Michael H. Bloch receives research support from Therapix Biosciences, Neurocrine Biosciences, Janssen Pharmacueticals, and Biohaven Pharmaceuticals. He also gratefully acknowledges additional research support from NIH, NARSAD, and the Patterson Foundation. Fenghua Li, Madeeha Nasir, and Baris Olten have no conflicts of interest that are directly relevant to the content of this article. This article was completed in compliance with the recommendations for the Conduct, Reporting, Editing and Publication of Scholarly work in Medical Journals’ issued by the International Committee for Medical Journal Editors.

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Li, F., Nasir, M., Olten, B.et al. Meta-Analysis of Placebo Response in Adult Antidepressant Trials.CNS Drugs33, 971–980 (2019). https://doi.org/10.1007/s40263-019-00662-y

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