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April 10, 2019

Are Placebo-Controlled, Relapse Prevention Trials in Schizophrenia Research Still Necessary or Ethical?

Author Affiliations
  • 1Department of Psychiatry, New York–Presbyterian Hospital, New York
  • 2Department of Psychiatry, Columbia University Medical Center, New York, New York
  • 3New York State Psychiatric Institute, New York
JAMA Psychiatry. 2019;76(7):673-674. doi:10.1001/jamapsychiatry.2019.0275

Randomized, placebo-controlled trials have been the gold standard for evaluating the safety and efficacy of new psychotropic drugs for more than half a century. Although the US Food and Drug Administration (FDA) does not require placebo-controlled trial data to approve new drugs or marketing indications, they have become the industry stand4ard for psychotropic drug development.

Placebos are controversial. The FDA guidelines state “when a new treatment is tested for a condition for which no effective treatment is known, there is usually no ethical problem with a study comparing the new treatment to placebo.”1 However, “in cases where an available treatment is known to prevent serious harm, such as death or irreversible morbidity, it is generally inappropriate to use a placebo control.”1(p15) When new antipsychotics are developed for schizophrenia, it can be debated which guideline applies.