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A randomized, prospective pilot study of patient expectancy and antidepressant outcome

Published online by Cambridge University Press:  13 September 2012

B. R. Rutherford ,
S. M. Marcus ,
P. Wang ,
J. R. Sneed ,
G. Pelton ,
D. Devanand ,
N. Duan  and
S. P. Roose
B. R. Rutherford*
Affiliation:
Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
S. M. Marcus
Affiliation:
New York State Psychiatric Institute, New York, NY, USA
P. Wang
Affiliation:
New York State Psychiatric Institute, New York, NY, USA
J. R. Sneed
Affiliation:
Queens College of the City University of New York, Flushing, NY, USA
G. Pelton
Affiliation:
Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
D. Devanand
Affiliation:
Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
N. Duan
Affiliation:
New York State Psychiatric Institute, New York, NY, USA
S. P. Roose
Affiliation:
Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
*
*Address for correspondence: Dr B. R. Rutherford, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA. (Email: brr8@columbia.edu)
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Abstract

Background

This study is a randomized, prospective, investigation of the relationships between clinical trial design, patient expectancy and the outcome of treatment with antidepressant medication.

Method

Adult out-patients with major depressive disorder (MDD) were randomized to either placebo-controlled (PC, 50% probability of receiving active medication) or comparator (COMP, 100% probability of receiving active medication) administration of antidepressant medication. Independent-samples t tests and analysis of covariance (ANCOVA) were used to determine whether the probability of receiving active medication influenced patient expectancy and to compare medication response in the PC v. COMP conditions. We also tested the correlations between baseline expectancy score and final improvement in depressive symptoms across study groups.

Results

Subjects randomized to the COMP condition reported greater expectancy of improvement compared to subjects in the PC condition (t = 2.60, df = 27, p = 0.015). There were no statistically significant differences in the analyses comparing antidepressant outcomes between subjects receiving medication in the COMP condition and those receiving medication in the PC condition. Higher baseline expectancy of improvement was correlated with lower final depression severity scores (r = 0.53, p = 0.021) and greater improvement in depressive symptoms over the course of the study (r = 0.44, p = 0.058).

Conclusions

The methods described represent a promising way of subjecting patient expectancy to scientific study. Expectancy of improvement is affected by the probability of receiving active antidepressant medication and seems to influence antidepressant response.

Keywords

Antidepressantclinical trialdepressionexpectancyplacebo effect
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 5 , May 2013 , pp. 975 - 982
Copyright
Copyright © Cambridge University Press 2012

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