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Letters to the Editor

Increasing Rates of Placebo Response Over Time in Mania Studies

Article Abstract

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Sir: There is indeed increasing concern about the high ratesof placebo response in randomized controlled trials in psychiatry,and particularly in the field of mood disorders, as shown inthe recent systematic review by Sysko and Walsh.1 But there isan alternative conclusion to the one that these authors provide intheir extensive review of placebo-controlled trials in mania,in which they state that factors related to study design accountfor high rates of placebo response: in our opinion, placebo responseseems to increase over time because of publication bias.Hence, because these authors used publication date for theiranalysis of the sequence of placebo response across mania trials,and not the actual date of study completion, the fact thatnegative studies have not been published or have been significantlydelayed in their publication has an obvious impact ontheir findings.’ ‹


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