***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Supportive social relationships , including a positive patient-practitioner relationship , have been associated with positive health outcomes . Using the data from a r and omized controlled trial ( RCT ) undertaken in the Boston area of the United States , this study sought to identify baseline factors predictive of patients ' response to an experimentally applied supportive patient-practitioner relationship . To sort through the hundreds of potential attributes affecting the patient-practitioner relationship , we applied a false discovery rate method borrowed from the field of genomics and bioinformatics . To our knowledge such a method has not previously been applied to generate hypotheses from clinical trial data . In a previous RCT , our team investigated the effect of the patient-practitioner relationship on symptom improvement in patients with irritable Bowel syndrome ( IBS ) . Data were collected on a sample of 289 individuals with IBS using a three-week , single blind , three arm , r and omized controlled design . We found that a supportive patient-practitioner relationship significantly improved symptomatology and quality of life . A complex , multi-level measurement package was used to prospect ively measure change and identify factors associated with improvement . Using a local false discovery rate procedure , we examined the association of 452 baseline subject variables with sensitivity to treatment . Out of 452 variables , only two baseline factors , reclusiveness , and previous trial experience increased sensitivity to the supportive patient-practitioner relationship . A third variable , additional opportunity during the study for subjects to discuss their illness through experiential interview , was associated with improved outcomes among subjects who did not receive the supportive patient-practitioner relationship . The few variables associated with differential benefit suggest that a patient-centered supportive patient-practitioner relationship may be beneficial for most patients . This may be especially important for reclusive individuals . Within the context of our study , additional study attention in the form of repeated experiential interviews compensated for a lack of positive patient-practitioner support . A supportive patient-practitioner relationship may also help overcome low provider expectations for subjects with previous trial experience . These results converge with the results of the parent trial , implicating the importance of the social world in healing Background It is an inherent assumption in r and omised controlled trials that the drug effect can be estimated by subtracting the response during placebo from the response during active drug treatment . Objective To test the assumption of additivity . The primary hypothesis was that the total treatment effect is smaller than the sum of the drug effect and the placebo effect . The secondary hypothesis was that non-additivity was most pronounced in participants with large placebo effects . Methods We used a within-subject r and omised blinded balanced placebo design and included 48 healthy volunteers ( 50 % males ) , mean ( SD ) age 23.4 ( 6.2 ) years . Experimental pain was induced by injections of hypertonic saline into the masseter muscle . Participants received four injections with hypertonic saline along with lidocaine or matching placebo in r and omised order : A : received hypertonic saline/told hypertonic saline ; B : received hypertonic saline+lidocaine/told hypertonic saline ; C : received hypertonic saline+placebo/told hypertonic saline+pain killer ; D : received hypertonic saline+lidocaine/told hypertonic saline+pain killer . The primary outcome measure was the area under the curve ( AUC , mm2 ) of pain intensity during injections . Results There was a significant difference between the sum of the drug effect and the placebo effect ( mean AUC 6279 mm2 ( 95 % CI , 4936–7622 ) ) and the total treatment effect ( mean AUC 5455 mm2 ( 95 % CI , 4585–6324 ) ) ( P = 0.049 ) . This difference was larger for participants with large versus small placebo effects ( P = 0.015 ) , and the difference correlated significantly with the size of the placebo effect ( r = 0.65 , P = 0.006 ) . Conclusion Although this study examined placebo effects and not the whole placebo response as in r and omised controlled trials , it does suggest that the additivity assumption may be incorrect , and that the estimated drug effects in r and omised controlled trials may be underestimated , particularly in studies reporting large placebo responses . The implication s for r and omised controlled trials and systematic review s need to be discussed BACKGROUND Depression is frequently found in patients with age-related macular degeneration ( AMD ) . The purpose of this study was to assess the effectiveness of escitalopram in treating major and minor depression in AMD patients . METHODS We conducted a crossover , r and omized , double-blind , placebo-controlled , 16-week study comparing escitalopram with placebo .  Inclusion criteria included reduced vision from AMD and major or minor depression , with a 17-item Hamilton Rating Scale for Depression ( HAMD-17 ) score of ≥10 . Participants were r and omly assigned to receive either escitalopram or placebo for 8 weeks and then crossed over to the other treatment . The primary outcome was change on the total HAMD-17 score  with escitalopram treatment compared with placebo . RESULTS We enrolled 16 AMD patients ( mean age 79.1 ) , 12 with major depression and 4 with minor depression . Mean HAMD-17 score at enrollment was 16.1 ± 4.2  , and mean visual acuity in the better eye was 20/70 . During escitalopram treatment , participants showed a significant reduction in HAMD-17 scores compared with placebo treatment ( P = .01 ) . CONCLUSIONS These findings suggest escitalopram may be an effective treatment for depressive symptoms associated with major or minor depression in AMD patients with vision loss OBJECTIVE The present study examined the efficacy and tolerability of acute escitalopram treatment in depressed patients aged 60 years or older . METHODS Patients aged > or = 60 years with Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition major depressive disorder were r and omized to 12 weeks of double-blind , flexible-dose treatment with escitalopram ( 10 - 20 mg/day ; N = 130 ) or placebo ( N = 134 ) . The prospect ively defined primary efficacy end point was change from baseline to week 12 in Montgomery-Asberg Depression Rating Scale ( MADRS ) total score using the last observation carried forward approach . RESULTS A total of 109 ( 81 % ) patients in the placebo group and 96 ( 74 % ) patients in the escitalopram group completed treatment . Mean age in both groups was approximately 68 years . Mean baseline MADRS scores were 28.4 and 29.4 for the placebo and escitalopram treatment groups , respectively . Escitalopram did not achieve statistical significance compared with placebo in change from baseline on the MADRS ( least square mean difference : -1.34 ; last observation carried forward ) . Discontinuation rates result ing from adverse events were 6 % for placebo and 11 % for escitalopram . Treatment-emergent adverse events reported by > 10 % of patients in the escitalopram group were headache , nausea , diarrhea , and dry mouth . CONCLUSIONS Escitalopram treatment was not significantly different from placebo treatment on the primary efficacy measure , change from baseline to week 12 in MADRS . In patients aged 60 years or older with major depression , acute escitalopram treatment appeared to be well tolerated The purpose of this study was to compare the effects of 16 weeks of a comprehensive exercise routine to supervised walking and social conversation on depression in nursing home residents with Alzheimer 's disease ( AD ) . Method : This study was a three-group , repeated- measures design with r and om assignment to treatment group . Forty-five nursing home residents with moderate to severe AD were r and omly assigned to a 16-week programme of comprehensive exercise , supervised walking or social conversation . Raters were blinded to treatment group assignment . Major outcome variables were depression measured by the Cornell Scale for Depression in Dementia , mood measured by the Dementia Mood Assessment Scale and the Alzheimer 's Mood Scale , and affect measured by the Observed Affect Scale . Depression was reduced in all three groups with some evidence of superior benefit from exercise .  Depression is a common problem with serious and costly consequences for nursing home residents with AD .  Exercise as a behavioural approach to treatment of depression in nursing home residents with severe AD evidence d a clear benefit to participants in this study . More research is needed to clarify the relative benefits of different types of exercise in conjunction with or without pharmacological intervention The logic of the r and omized double-blind placebo control group design is presented , and problems with using the design in psychotherapy are discussed .  Placebo effects are estimated by examining clinical trials in medicine and psychotherapy . In medicine , a recent meta- analysis of clinical trials with treatment , placebo , and no treatment arms was conducted ( Hróbjartsson & Gøtzsche , 2001 ) , and it was concluded that placebos have small or no effects . A re- analysis of those studies , presented here , shows that when disorders are amenable to placebos and the design is adequate to detect the effects , the placebo effect is robust and approaches the treatment effect . For psychological disorders , particularly depression , it has been shown that pill placebos are nearly as effective as active medications whereas psychotherapies are more effective than psychological placebos . However , it is shown that when properly design ed , psychological placebos are as effective as accepted psychotherapies BACKGROUND Pill-taking , expectations and therapeutic alliance may account for much of the benefit of medication and placebo treatment for major depressive disorder ( MDD ) . Aims To examine the effects of medication , placebo and supportive care on treatment outcome , and the relationships of expectations and therapeutic alliance to improvement . METHOD A total of 88 participants were r and omised to 8 weeks of treatment with supportive care alone or combined with double-blind treatment with placebo or antidepressant medication .  Expectations of medication effectiveness , general treatment effectiveness and therapeutic alliance were measured ( trial registration at Clinical Trials.gov : NCT00200902 ) . RESULTS Medication or placebo plus supportive care were not significantly different but had significantly better outcome than supportive care alone . Therapeutic alliance predicted response to medication and placebo ; expectations of medication effectiveness at enrolment predicted only placebo response . CONCLUSIONS Pill treatment yielded better outcome than supportive care alone . Medication expectations uniquely predicted placebo treatment outcome and were formed by time of enrolment , suggesting that they were shaped by prior experiences outside the clinical trial A previously tested theoretical model that specifies relationships among depression , activities of daily living ( ADL ) impairment , and social support components was vali date d with 307 patients aged 60 and older from a multisite effectiveness trial of 3 treatments ( antidepressant , placebo , Problem-Solving Treatment )  for dysthymia or minor depression in primary care . Participants completed interviews and self-reports at baseline and at 6 and 12 weeks . The short-term , longitudinal data were analyzed with covariance structure modeling techniques . Consistent with the previous model , impairment in ADLs was associated with subsequent increases in depression , a larger emotionally close network that made frequent visits was associated with subsequent increases in perceived support , and perceived support was associated with subsequent decreases in depression . This last effect was significant only among participants r and omly assigned to receive placebo with clinical management . The similar results in 2 different studies are a substantial validation of the theoretical model . The effect of perceived support primarily in the placebo group suggests that those with greater perceived social support and subsyndromal depression may be more likely to have a positive response to nonspecific clinical treatment components CONTEXT Insufficient evidence exists for recommendation of specific effective treatments for older primary care patients with minor depression or dysthymia . OBJECTIVE To compare the effectiveness of pharmacotherapy and psychotherapy in primary care setting s among older persons with minor depression or dysthymia . DESIGN R and omized , placebo-controlled trial ( November 1995-August 1998 ) . SETTING Four geographically and clinical ly diverse primary care practice s. PARTICIPANTS A total of 415 primary care patients ( mean age , 71 years ) with minor depression ( n = 204 ) or dysthymia ( n = 211 ) and a Hamilton Depression Rating Scale ( HDRS ) score of at least 10 were r and omized ; 311 ( 74.9 % ) completed all study visits . INTERVENTIONS Patients were r and omly assigned to receive paroxetine ( n = 137 ) or placebo ( n = 140 ) , starting at 10 mg/d and titrated to a maximum of 40 mg/d , or problem-solving treatment- primary care ( PST-PC ; n = 138 ) . For the paroxetine and placebo groups , the 6 visits over 11 weeks included general support and symptom and adverse effects monitoring ; for the PST-PC group , visits were for psychotherapy . MAIN OUTCOME MEASURES Depressive symptoms , by the 20-item Hopkins Symptom Checklist Depression Scale ( HSCL-D-20 ) and the HDRS ; and functional status , by the Medical Outcomes Study Short-Form 36 ( SF-36 ) physical and mental components . RESULTS Paroxetine patients showed greater ( difference in mean [ SE ] 11-week change in HSCL-D-20 scores , 0.21 [ 0 . 07 ] ; P = .004 ) symptom resolution than placebo patients . Patients treated with PST-PC did not show more improvement than placebo ( difference in mean [ SE ] change in HSCL-D-20 scores , 0.11 [ 0.13 ] ; P = .13 ) , but their symptoms improved more rapidly than those of placebo patients during the latter treatment weeks ( P = .01 ) . For dysthymia , par 
    Output:
    
Baseline severity was not associated with an antidepressant-placebo difference and placebo responses are large in the treatment of depressed elderly people .