The 2023 Royal College of Psychiatrists International Congress, held in Liverpool, ‘brought together delegates from 53 countries to network, share best practices, and learn about the latest mental health research.’
In a talk on dementia, Professor Rob Howard explained why he uses antidepressants even though research evidence has established that they are no better than placebo for this group.
To play this clip of Professor Rob Howard’s rationale for using antidepressants in patients with dementia, please click here.
TRANSCRIPT of this clip:
Professor Rob Howard: “The number of people who dipped below having a Cornell Scale score of less than 10 was the same in all three groups. So we have to think about what happens when you get an antidepressant or a placebo? What do you get?
You get your own expectation that the treatments working or might work for you. You get the expectation of hope of the team who are treating you that they have an intervention that they can give you, and that they can do something . You have the experience of going to be followed up and assessed, and, and you know someone actually asking how are you getting on.
And, you know, in an era of evidence-based medicine, we may not like to think that some of what we do is placebo. I don’t believe that everything we do is placebo, as we are told by some of our colleagues, but honestly some of what we do is placebo and its important and if it helps patients and their families its a good thing.
So I don’t think it is surprising that we have just completed the large trial of a psychological therapy for people who are depressed, eh, with dementia and you know, we had 336 patients and half of them were taking antidepressants that they had been started for the treatment of their depression despite the fact that Trials like this had shown that antidepressants are no better than placebo.
And, I have to say, I, I, should say I am being filmed by somebody I know has rather critical views about psychiatry, but, em, I treat depression in people with dementia with an antidepressant, but when I do so I explain to families that actually the Trials have shown that the drugs are no better than placebo but that people get better when they get the drug or the placebo and that’s important that we should tap into it.
Obviously what we need is Trials that don’t just look at drug and placebo but also look at an arm where nothing happens. You know where treatment as usual happens, because, and my prediction would be that there will be a difference between those. Until we have those of course we don’t have an evidence base, that can back up what I say. But I don’t lie to my patients and their families and say to them antidepressants are really great, I explain about the placebo. And generally, people are sensible and sophisticated and they get it.”