Psychiatry - July 2008 - (Page 25)

[letters to the editor] reimbursement is based upon number of patients enrolled, there is an unconscious bias to rate the depressive symptoms higher than they are to help patients meet the inclusion criteria. The patients with milder and atypical forms of depression often show high therapeutic response to placebo and psychosocial interventions thus diluting the evidence of an antidepressant’s efficacy with the more severely depressed. Furthermore, the mildly depressed are more likely to show decline of their symptoms spontaneously irrespective of the treatment. This also works against showing differences between the antidepressant and the placebo. Two: Once the patient is enrolled in the study, there is a strong incentive to rate the treatment response liberally. The investigator has a powerful motivation to see that the drug works. If the drug is effective, it means publication and the honor of bringing a new drug to the market. Thus, when rating the treatment response, there is an unconscious bias to show greater improvement than what is actually occurring. This once again dilutes the differences between the antidepressant and placebo response. LETTERS TO THE EDITOR SUBMISSIONS The above two factors were borne upon me while doing my first clinical trial—a four-week, doubleblind, placebo–controlled study in depression. I observed how eager we were to enroll anyone who declared himself or herself to be depressed during the screening rounds that we conducted with all the new admissions throughout the state hospital where the research unit was situated. To enable patients to meet the study’s inclusion criteria, there was a strong inner compulsion to downplay comorbid conditions and to exaggerate the intensity of the depression. It did not take me long to realize that all the research subjects were improving quite rapidly, and, therefore, the study would run into the problem of falsely showing that the antidepressant was no better than placebo. REFERENCES 1. Feifel D. More depressing news on antidepressants: Should we panic? Psychiatry (Edgemont) 2008;5(4)–35–36. With regards, Surendra Kelwala MD Livonia, Michigan Psychiatry 2008 welcomes submissions for possible publication in the Letters section. Letters should be no more than 500 words and five references. Type with double spacing. Letters that comment on a Psychiatry 2008 article will be considered if they are received within two months of the time the article was published. All letters are reviewed by the editors and are selected based upon interest, timeliness, and pertinence, as determined by the editors. There are no guarantees a letter will be published. Letters that are not intended for publication by the authors should state this in the body of the letter. Published letters are edited and may be shortened; tables and figures are included only selectively. Send letters to: Elizabeth Klumpp, Executive Editor, Psychiatry 2008, editorial@matrixmedcom.com. Hard copy submissions are no longer accepted. Include the following statement with the letter: “The undersigned author transfers all copyright ownership of the enclosed/attached letter to Matrix Medical Communications in the event the work is published. The undersigned author warrants that the letter is original, is not under consideration by another journal, and has not been previously published. I sign for and accept responsibility for releasing this material on behalf of any and all co-authors.” Psychiatry 2008 25 [JULY]

Table of Contents Feed for the Digital Edition of Psychiatry - July 2008

Psychiatry - July 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Reliability of Diagnoses: Do Psychiatrists Use Structured Interviews In Real Clinical Settings? Trend Watch: Use of Atypical Antipsychotics in the Elderly Review: The Struggle for Mental Healthcare in New Orleans-One Case at a Time Psychotherapy Rounds: Psychotherapeutic and Adjuntive Pharmacologic Approaches to Treating Posttraumatic Stress Disorder Original Research: Baseline Dissociation and Prospective Success in Special Forces Assessment and Selection Commentary: Performance-Enhancing Drugs: Where Should the Line Be Drawn and By Whom? Commentary: Psychiatric Diagnosis and the Pathlogist's View of Schizophrenia Journal Watch Classified Advertising Information for Authors

Psychiatry - July 2008

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