> placebo that turned out to be escitalopram, an SSRI antidepressant.
How is this a placebo?
How is this a placebo?
Using an anti-depressant as placebo for a test regarding anti-depressive effects does seem a bit odd, but it is fine if the test is for effects or durations exceeding the capability of placebo drugs.
Niacin, not nicotine.
See the so-called "niacin-flush" response:
> The open-label trial had the additional criteria of TRD, as defined by no improvement despite multiple courses of antidepressant medication (mean = 4.6 ± 2.6 past medications; range, 2–11)
If i'm reading the study properly (disclaimer: I may not be) then the patients in the open-label trial had already failed an average of 4.6 typical antidepressants. So it's unlikely that they'd be responding to a starter dose of another SSRI (10mg escitalopram, though some were on 20mg perhaps by body weight)
see also https://en.wikipedia.org/wiki/Placebo#In_research_trials
>Some suggest that existing medical treatments should be used instead of placebos, to avoid having some patients not receive medicine during the trial.
It discusses medical treatments used instead of placebos, rather than as placebos.
I think the more accurate term here would be "control", not "placebo". It arguably could create or enhance a placebo effect with respect to psilocybin, but I think "control" would be less confusing terminology to refer to the non-psilocybin substance. Then again, they're the research university and I'm a random internet commenter, so they probably have more authority on this than I do.
>An active placebo is a placebo that produces noticeable side effects that may convince the person being treated that they are receiving a legitimate treatment, rather than an ineffective placebo.
>An example of an active placebo is the 1964 work of Shader and colleagues who used a combination of low-dose phenobarbital plus atropine to mimic the sedation and dry mouth produced by phenothiazines.
>Morphine and gabapentin are painkillers with the common side effects of sleepiness and dizziness. In a 2005 study assessing the effects of these painkillers on neuropathic pain, lorazepam was chosen as an active placebo because it is not a painkiller but it does cause sleepiness and can cause dizziness.
Here, it seems like an example active placebo might be something that induces nausea, since psilocybin is known to induce nausea. SSRIs are not just an active placebo but something that actually attempts to treat the primary symptom: depression. The above paragraph suggests lorazepam would be a good active placebo for testing painkillers because it is not a painkiller; here, an antidepressant is being compared with an antidepressant.
So I was wrong to say that it's not a placebo if it's a psychoactive molecule. I just don't think it is if it's a psychoactive molecule that's treating the primary symptom you're attempting to find a treatment for.
There's also the ethical limitations of taking someone off a medication they need for their wellbeing to try something else, which is largely not allowed which makes trialing certain alternatives difficult and complex.
Another example would be determining something about mystic experiences and testing amphetamine against psilocybin. You need something active, because otherwise even a drug-naive participant quickly groks they're on sugar and not an actual drug
It probably also helped that these were people who'd never tried MDMA.. so they didn't really know what to expect.
Also, in microdosing studies, I think even sugar pills could be very effective placebos.
edit: see another comment suggesting that control is the right term for this rather than placebo - face palm moment.