A Literature Analysis on the Ethics of Placebo Administration to Depressed Patients in Clinical Practice

Abstract

The placebo forms the backbone of nearly all clinical drug trials by functioning as a control to assess the efficacy of an active drug. The administration of the placebo in clinical practice has stimulated controversy within the medical community because, often, physicians deceive patients to extract the placebo effect. The American Medical Association’s guidelines for administering placebos in clinical practice—which state that using placebos without informed consent is a threat to the doctor-patient relationship—are contradictory and may inhibit the promotion of a placebo effect. A greater comprehension of clinical placebo administration will allow the medical community to

assess if the benefits of the placebo can be harnessed without compromising the traditional values of medicine.

This literature analysis focuses on the placebo effect in patients with depression. After analyzing previous studies from academic databases, three primary aspects of the placebo effect were examined: The strength of the placebo

effect, the mechanisms by which the placebo effect occurs, and the ethics of placebo use in clinical practice.

This analysis reveals that the response rates of patients in the placebo groups for antidepressant trials are high, thus lending the possibility that the placebo could be clinically beneficial to depressed patients. The two primary contributing factors to the placebo effect seem to be the doctor-patient relationship and a neurological mechanism of action. Furthermore, because treatment with a placebo would be only part of any therapy for depressed patients, the placebo should be considered an ethical treatment option for depressed patients. In order for physicians to minimize the issue of deception when administering placebos, it may be possible to obtain informed consent without compromising the benefits of the placebo effect. Further research should focus on administering placebos without

deception to depressed patients, ensuring representativeness by studying large sample sizes.