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    Symptom trajectories in discontinuation trials.

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    Date
    2017-02
    Author
    Browning, Michael
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    Citation
    Browning, M., 2017. Symptom trajectories in discontinuation trials. Lancet Psychiatry 4, 176–178
    Abstract
    Many patients with clinical depression, particularly those with recurrent illness, are treated with maintenance antidepressants after an acute-phase response. But how effective is this approach? The effectiveness of maintenance treatment is most commonly tested in trials with a discontinuation design, 1 in which patients who have already responded to a treatment are randomly assigned to either ongoing treatment or placebo. Such studies provide a measure of the benefit of maintenance treatment over discontinuation. However, discontinuation studies have several limitations. The first is common to psychiatric treatment studies generally; how and when should we assess whether a patient's symptoms have changed after discontinuation? The second is more specific to discontinuation designs; the selection of patients based on a positive response to that treatment is likely to inflate the apparent beneficial effect of the treatment, because that subgroup of patients has the most to lose from stopping treatment.
    URI
    https://oxfordhealth-nhs.archive.knowledgearc.net/handle/123456789/702
    Published online at:
    https://doi.org/10.1016/S2215-0366(17)30054-8
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