Combined Cognitive-Behavioral Therapy and Placebo Treatment for Patients with Depression: A Follow-Up Assessment

Placebo effects during the waiting period for psychotherapy in patients with depression

Patients with mental health problems typically have to wait for psychological therapies. This study aimed to investigate the effects of a placebo administered to patients with depression while they were waiting for cognitive-behavioral therapy. Sixty-seven patients were randomly assigned to a three-week waiting period with or without treatment with a take-home placebo for daily usage (herbal medicine to mobilize the body’s natural healing powers to be taken orally). Symptoms of depression (self-rated and clinician-rated) were assessed at the beginning and end of the waiting period. Moreover, each week the patients evaluated levels of energy, concentration, relaxation, well-being, and sleep quality. The placebo group showed a greater reduction in symptoms of depression (self-rated and clinician-rated) compared to the standard group. Moreover, placebo treatment was associated with improved overall well-being during the waiting period. In conclusion, placebo treatment can make the wait time for psychotherapy more tolerable for patients with depression.

Clinical trial registration: German Clinical Trials Register (DRKS00028118)

Open-label placebos as adjunctive therapy for patients with depression

Background

Placebos prescribed as 'regular' medication can reduce symptoms of depression. However, using a placebo without patients' informed consent presents ethical issues. Therefore, the present study assessed the efficacy of an open-label placebo (OLP), which was administered concurrently with cognitive-behavioral therapy (CBT).

Methods

Sixty patients (mean age: 48 years) diagnosed with major depressive disorder were randomly assigned to a 4-week CBT outpatient program with or without daily OLP treatment. The patients were assessed directly before and after the program as well as three months after the therapy.

Results

Compared to the CBT group, the CBT + OLP group showed a greater reduction in symptoms of depression at the end of the program. Changes in categories pertaining to severity of depression did not differ between groups. All patients completed the program. Noncompliance with the follow-up appointment differed significantly between CBT + OLP (27%) and CBT (7%). Noncompliance was associated with a negative evaluation of the OLP.

Conclusions

The OLP intervention reduced symptoms of depression, however, these changes were not clinically meaningful. The OLP increased the risk for loss to follow-up. The high dropout rate in the present study raises questions concerning the acceptance of OLPs in the treatment of depression.