Are child and adolescent responses to placebo higher in major depression than in anxiety disorders? A systematic review of placebo-controlled trials.
BACKGROUND
In a previous report, we hypothesized that responses to placebo were high in child and adolescent depression because of specific psychopathological factors associated with youth major depression. The purpose of this study was to compare the placebo response rates in pharmacological trials for major depressive disorder (MDD), obsessive compulsive disorder (OCD) and other anxiety disorders (AD-non-OCD).


RESULTS
We reviewed the literature relevant to the use of psychotropic medication in children and adolescents with internalized disorders, restricting our review to double-blind studies including a placebo arm. Placebo response rates were pooled and compared according to diagnosis (MDD vs. OCD vs. AD-non-OCD), age (adolescent vs. child), and date of publication. From 1972 to 2007, we found 23 trials that evaluated the efficacy of psychotropic medication (mainly non-tricyclic antidepressants) involving youth with MDD, 7 pertaining to youth with OCD, and 10 pertaining to youth with other anxiety disorders (N = 2533 patients in placebo arms). As hypothesized, the placebo response rate was significantly higher in studies on MDD, than in those examining OCD and AD-non-OCD (49.6% [range: 17-90%] vs. 31% [range: 4-41%] vs. 39.6% [range: 9-53], respectively, ANOVA F = 7.1, p = 0.002). Children showed a higher stable placebo response within all three diagnoses than adolescents, though this difference was not significant. Finally, no significant effects were found with respect to the year of publication.


CONCLUSIONS
MDD in children and adolescents appears to be more responsive to placebo than other internalized conditions, which highlights differential psychopathology.
Cohen
David
D
Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, GH Pitié-Salpétrière, AP-HP, Paris, France. david.cohen@psl.aphp.fr
Deniau
Emmanuelle
E
Maturana
Alejandro
A
Tanguy
Marie-Laure
ML
Bodeau
Nicolas
N
Labelle
Réal
R
Breton
Jean-Jacques
JJ
Guile
Jean-Marc
JM
D000328:Adult; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000523:psychology*; D002648:Child; D018849:Controlled Clinical Trials as Topic; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000523:psychology*; D010919:Placebos
D010919:Placebos