Dr. Douglas Berger’s response to “Top Papers That Can Change Your Practice” by By, Sy Atezaz Saeed, MD, MS and Richard M. Bloch, PhD


Article Originally Published in the ‘Psychiatric Times’ on February 23, 2017

Drs. Saeed and Bloch,

You quoted a paper on IPT as showing IPT to be more effective than placebo or waiting list and comparable to pharmacotherapies.

Did this paper, or any paper, ever study IPT with single-blinding (=subject blind) or double-blinding (and thus with blind placebo) ? I think not as it is impossible to blind a psychotherapy study, using the term “placebo” in a psychotherapy study is misleading as it is not a blind placebo.

In addition, comparing IPT to medications that show efficacy vs blind placebo (thus the rigor in showing efficacy is higher than in unblinded studies) invalidates clinical trial logic because the methods to prove efficacy are very different in blinded medication studies vs psychotherapy studies. MDD is studied with subjective endpoints and an unblinded study can not filter bias from the expectation and hope of knowing the therapy one is given. Blind raters only record the unblinded report of the subjects.

Because MDD psychotherapy trials can not be single- or double-blinded, nor can they have blind placebo, the rigor of these trials for psychotherapy in MDD is low so that it is premature to make claims of efficacy for IPT in MDD. These kinds of papers do not belong in a “Top Ten” list unless you want to include “papers with problems to be aware of” in the list.

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