Treatment-induced stress syndromes

SummaryPlacebo controlled trials in disease states as currently constituted are designed to show a drug “works” when in fact it may not. Efficacy of this type may be constructed in trials that demonstrate some marginal superiority of a drug over placebo in disease states that do not take into account any potentialities of the drugs being tested to cause dependence and consequent deleterious effects on withdrawal. This paper reviews the history of the concept of physical dependence. While outlined in terms of the psychotropic drugs, it will be clear that such has been the neglect of this feature of drug actions that it must, until proven otherwise, be assumed to apply to all drugs. Filling the gap in our knowledge would require studies of new compounds in healthy volunteers. In the absence of such studies, any clinical information on therapeutic agents should point to the lack of information on this matter.