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January 7, 2004

Efficacy of Sertraline in the Treatment of Children and Adolescents With Major Depressive Disorder

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(1):40. doi:10.1001/jama.291.1.41-b

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 practice.

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