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Abstract
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In the Alpha-Stim Anxiety Insomnia and Depression cranial electrotherapy stimulation trial, Richard Morriss and colleagues reported no significant difference in their primary depression outcome between active and sham groups.
Although not the headline of the article, 41% of recruited patients who received sham stimulation had remission of their depression. This remarkable result adds to the growing list of neurotechnology trials in psychiatry demonstrating very large responses in their placebo arms. For example, the largest recent sham-controlled trial of transcranial magnetic stimulation for treatment-resistant depression showed a similarly impressive 37% remission rate in the sham transcranial magnetic stimulation group.2
It is surprising that in an article with such results the authors do not mention or discuss placebo effects. Morriss and colleagues rightfully conclude that active stimulation was no more effective than sham stimulation but do not consider more deeply how the placebo response might have contributed to the beneficial effect of sham stimulation. Unfortunately, the omission of discussion on placebo effects is pervasive in neuromodulation trials of this nature, even when the results are so evident. It is more common for authors to focus on unsubstantiated theories to discredit placebo responses (eg, the sham must be active) rather than address potential patient-related or treatment-related factors that could be driving large positive expectancies and placebo responses...
Language: en |