Placebo effect in child and adolescent psychiatric trials.
Much literature has been written in the field of child psychiatry regarding the placebo as a tool to test drug efficacy in clinical trials, but quite little regarding the placebo effect itself or its clinical use in child psychiatry. In this article, we aim to critically review the literature regarding the placebo effect in children and adolescents with mental disorders, focusing especially on factors influencing the placebo effect and how they may influence the interpretation of clinical trials. The placebo effect seems to be more marked in children than adults, and particularly in children and adolescents with depression, although it is pervasive across ages and is present in non-psychiatric conditions as well. The use of a placebo in clinical trials as a comparator with drugs that have moderate efficacy at most makes it difficult to obtain positive results, and much effort is needed to design very high quality clinical trials that may overcome the limitations of using a placebo. In addition, the placebo effect across ages and clinical conditions must be tested directly (compared with no treatment whenever possible), in order to characterise which placebos work for what and to determine their use in clinical settings.
Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM, Madrid, Spain. parellada@hggm.es
Mara
M
Parellada
Carmen
C
Moreno
Miguel
M
Moreno
Ana
A
Espliego
Enrique
E
de Portugal
Celso
C
Arango
D000293:Adolescent; D041923:Adolescent Development / Q000187:drug effects; D002648:Child; D002657:Child Development / Q000187:drug effects; D018849:Controlled Clinical Trials as Topic / Q000523:psychology*; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy* / Q000523:psychology*; D055495:Neurogenesis / Q000187:drug effects; D015990:Placebo Effect; D010919:Placebos / Q000009:adverse effects / Q000627:therapeutic use; D000297:Psychology, Adolescent / Q000379:methods*; D002666:Psychology, Child / Q000379:methods*; D011600:Psychopharmacology / Q000379:methods*; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use
D010919:Placebos; D011619:Psychotropic Drugs