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November 1984

Placebo-Control Groups in the Study of Outpatient Depressives

Author Affiliations

Office of Mental Health New York State Psychiatric Institute 722 W 168th St New York, NY 10032

Arch Gen Psychiatry. 1984;41(11):1110. doi:10.1001/archpsyc.1983.01790220100016

To the Editor.—  The article by Murphy et al1 on cognitive therapy and pharmacotherapy is timely and important. However, the group that was treated with tricyclic antidepressants (TCAs) may have contained a high proportion of placebo responders. This would compromise the usefulness of the TCA group as a relevant standard.Murphy et al contrasted four treatments (cognitive therapy, TCAs, cognitive therapy and TCAs, and cognitive therapy and placebo). There was no initial placebo washout period nor was there a parallel placebo group. The efficacies of the treatments were indistinguishable. Depending on the criteria, 44% to 56% of the TCA group were successfully treated.We suspect that a majority of these patients were placebo responders for the following reasons: Fig 2 indicates that the TCA-treated group had approximately a 12-point improvement in their Hamilton Rating Scale for Depression (HAM-D) scores during the first six weeks; two thirds of this improvement

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