Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Wagner and colleagues1 compared sertraline with a placebo. The scientific
and ethical justification of such an experimental design is questionable.
Kupfer and Frank2 recently discussed the
pitfalls of placebo-controlled, multicenter, outpatient randomized clinical
trials for the study of effectiveness of antidepressant medications. Kupfer
and Frank acknowledged "the variability in placebo response from trial to
trial" and stated that the placebo response "has increased significantly in
recent years." Furthermore, because the authors excluded patients at risk
of suicide, their sample may have comprised patients with only moderate depression.
For these reasons, it is difficult to generalize these results to clinical
Solyom AE. Efficacy of Sertraline in the Treatment of Children and Adolescents With Major Depressive Disorder. JAMA. 2004;291(1):40. doi:10.1001/jama.291.1.41-b