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Drop-out and intention to treat

Posted by plosmedicine on 31 Mar 2009 at 00:22 GMT

Author: Richard Gill
Position: Professor, mathematical statistics
Institution: Leiden University, Netherlands
Submitted Date: March 02, 2008
Published Date: March 3, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

I understand that in these trials about half of the patients did not "complete the treatment". And this percentage was slightly higher in the treatment than the placebo groups! It is very sound practice in randomized clinical trials to compare treatment and control groups on the "intention to treat principle". And in studying antidepressants, since still being around after six weeks and still swallowing the pills can be considered in itself a positive outcome.

Like previous writers here, I am astonished that the studies had such a short duration. My personal experience from several medium-severe bouts of depression, is that the standard initial dose does nothing, and it needs to be increased once or twice before there is any effect. A careful doctor waits five or six weeks before recommending a higher dose. Then four or five weeks after the good dose has been found, the depression raises "overnight", completely and dramatically.

So should I ask my doctor, next time, to give me a placebo?

No competing interests declared.