Placebo Effect in the Treatment of Depression and Anxiety

Kirsch, Irving

doi:10.3389/fpsyt.2019.00407

Cited by 144 publications

(101 citation statements)

References 75 publications

(58 reference statements)

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“…https://orcid.org/0000-0002-6244-1747 Notes 1. Some authors (see Blease et al, 2017;Kirsch, 2019;Kirsch & Sapirstein, 1999) have sought to stipulate a distinction between the terms "placebo response" and "placebo effect." Kirsch…”

Section: Fundingmentioning

confidence: 99%

The “placebo” paradox and the emotion paradox: Challenges to psychological explanation

Hutchinson

2020

Theory & Psychology

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Philosophical debates about how best to explain emotion or placebo are debates about how best to characterise and explain the distinctive form of human responsiveness to the world that is the object of interest for each of those domains of inquiry. In emotion research, the cognitive theory of emotion faces several intractable problems. I discuss two of these: the problem of epistemic deficit and the problem of recalcitrant emotions. Cognitive explanations in Placebo Studies, such as response-expectancy and belief-based explanations, also face the problem of epistemic deficit in addition to the problem of logically self-destructive true belief. While such considerations might motivate a retreat to affect, this brings its own problems. I argue that it is a particular version of cognitivism, representational cognitivism (Rep-Cog), that generates the paradoxes we encounter in emotion and placebo research. I propose that turning to nonrepresentational accounts of cognition will dissolve these paradoxes. As I move toward conclusion, I propose drawing on the ethnomethodological tradition to respecify human responsiveness to loci of significance in the lifeworld by undertaking ethnographies of members’ own situated methods for making intelligible and accountable their attitudinal and nonattitudinal responsiveness to loci of significance in their environment.

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Section: Fundingmentioning

confidence: 99%

The “placebo” paradox and the emotion paradox: Challenges to psychological explanation

Hutchinson

2020

Theory & Psychology

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“…First, the lack of a placebo control condition is a major limitation. Whether the observed decrease in depression scores after treatment reflects the therapeutic action of ketamine, or unspecific placebo effects, remains unclear (Kirsch, 2019). In addition, the lack of a control group does not allow controlling for the effects of regression to the mean on the average decrease of MADRS total scores we observed.…”

Section: Discussionmentioning

confidence: 89%

Sustained Improvement of Negative Self-Schema After a Single Ketamine Infusion: An Open-Label Study

et al. 2020

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Conventional antidepressants have several important limitations, including a lack of direct effects on negative self-schema, which is at the core of Beck's cognitive theory of depression. Based on previous studies showing a positive effect of ketamine on negative cognition, we compared reductions in negative self-schema between responders and non-responders to a single infusion of ketamine. In an open-label study, 26 participants with treatment-resistant depression received 0.5 mg/kg ketamine via infusion. Depression symptoms were assessed at baseline, 24 h, and 7 days after treatment with Montgomery-Åsberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI-II). Nine of the 26 participants fulfilled response criteria after 24 h. Of these, eight still fulfilled response criteria after 7 days. Response was defined as a reduction in MADRS total score of 50% or more. Responders improved significantly more than non-responders both 24 h and 7 days after ketamine treatment on the following BDI-II items: item 1 ("Sadness"), item 7 ("Self-Dislike"), and item 8 ("Self-Criticalness"). These results suggest an important therapeutic effect of ketamine on negative self-schema, which is a fundamental cognitive aspect of depression. This effect is unique and might be associated with ketamine's profound effects on neuroplasticity. Small sample size and lack of a placebo control group are the major limitations of this study.

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“…The synergistic effect of DMARDs and antidepressants needs to be studied further. In this context it is also important to be mindful of the placebo effects in the treatment of depression and anxiety, as analyses of the majority of published clinical trial data on antidepressants demonstrate that the difference in improvement between drug and placebo is not clinically meaningful [50].…”

Section: Biologic Disease-modifying Anti-rheumatic Drugs In the Treatmentioning

confidence: 99%

Depression in Psoriatic Arthritis: Dimensional Aspects and Link with Systemic Inflammation

Mathew

Chandran

2020

Rheumatol Ther

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Studying comorbidities in patients with psoriatic arthritis (PsA) provides a better understanding of the extended burden of the disease. Depression and anxiety are well recognized but understudied comorbidities in patients with PsA. The prevalence of depression is significantly higher in this patient population than in the general population, with far reaching consequences in terms of long-term quality of life. Over the past few years there has been an increasing interest in the link between inflammation and depression, with several novel studies being conducted. Recent evidence suggests a significant improvement of depression in PsA patients treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs) as compared to conventional DMARDs. Depression in PsA is multidimensional, with recognized phenotypes, including cognitive disorder, alexithymia and anhedonia. The paucity of standardized, validated tools to screen these dimensional phenotypes remains an unmet need. Prevalence studies on depression in patients with PsA, mostly based on patient-reported outcomes, are only able to highlight the tip of the iceberg. A comprehensive, multidisciplinary approach addressing the subdomains of depression is imperative for a better understanding of depression in PsA patients, as well as to find a way forward for improving their quality of life. In this scoping review, we explore existing evidence on the burden of depression in PsA patients, the link between inflammation and depression in these patients and the screening tools used to evaluate the subdomains of depression.

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Placebo Effect in the Treatment of Depression and Anxiety

Cited by 144 publications

References 75 publications

The “placebo” paradox and the emotion paradox: Challenges to psychological explanation

The “placebo” paradox and the emotion paradox: Challenges to psychological explanation

Sustained Improvement of Negative Self-Schema After a Single Ketamine Infusion: An Open-Label Study

Depression in Psoriatic Arthritis: Dimensional Aspects and Link with Systemic Inflammation

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