Long Live the Placebo!
Compared with placebo, the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression. That’s according to a new meta-analysis of clinical trials research. A triumph for the placebo effect! How does it work?
The study — fully available online — on the benefits of four new generation antidepressants which made the headlines a couple of days ago shows clearly that the drug companies have been skewing their statistics for years. The researchers conducted a meta-analysis of data from all clinical trials (not just trials with positive results) of the drugs in question submitted to the US Food and Drug Administration.
The researchers found that:
…compared with placebo, the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression, but show significant effects only in the most severely depressed patients. The findings also show that the effect for these patients seems to be due to decreased responsiveness to placebo, rather than increased responsiveness to medication.
So it is not that antidepressants do not have any effect on depression. They do. But taking tablets which you think are antidepressants may have essentially the same effect! (Pass the chocolate!)
Excuse my flippancy, I think this is actually a really important issue, and a ray of light in the gloom that may descend when we contemplate that those bright shiny scientific new drugs “don’t work”. Or indeed, that our last hope for some way out of the darkness may be an illusion.
The placebo effect shows us that wherever depression “comes from”, be it a chemical imbalance, a learned thinking pattern, an emotional response to life experiences, a freak of fate, it can be significantly affected by our positive actions to do something about it, our intention to be well.
The way this active, positive intention is expressed in “our” dominant culture, is actually a passive one — taking a tablet which will do the work for us, because we trust that experts have invented something that works. Questions arise. Does the method need to be passive? Is the healing factor something about giving up the struggle and surrendering? Something about the trust that must be there before we can do that? Or is it only a cultural factor at play here, suggesting to us that this is how you take an active step towards beating your depression? Is this culture beginning to change?
However we do it, we are managing to do it. Probably some of us are surrendering to expert knowledge, some surrendering in the sense of finally giving up a futile and counterproductive struggle which was only making us feel worse, some taking a proactive step, some will feel it is empowering to see depression as a ‘brain fault’ and nothing to do with their essential self. But in general, just by taking a few pills we are setting underway a healing process in the whole organism. We are getting better from depression.
And those who do not take antidepressants may also be healing themselves by defining themselves as not “defective” or as not surrendering to experts. Some of these people come to me as clients, having never picked up their prescriptions. They found being prescribed antidepressants empowering in the sense that it mobilised them to do something else. For these people counselling is generally effective.
The placebo effect would be impossible (surely?!) to study in therapy, as even an untrained volunteer would be able to lend a listening ear and a certain amount of acceptance and respect. However I am sure that the sheer fact of deciding to come to counselling and doing that has a huge effect on bringing about healing from depression, quite independently of what actually happens in therapy (as long as what happens there is not actively destructive!)
The way people relate to their antidepressants is always personal and unique; a client once said to me that he was so depressed while taking antidepressants that he knew it couldn’t be depression! Of course it could have been that they did not work, but he chose to believe that this was a sign to sort his life out rather than worrying about what was wrong with his brain. He made a life changing practical decision and felt better.
The fact that severely depressed people are not so susceptible to the placebo effect is interesting, suggesting that there is a certain point beyond which our intentions to get well, our life force, or actualising tendency or whatever you want to call it, becomes deadened by depression, and can no longer make use of the opportunities available. The person truly no longer cares one way or the other. In this case it is just as well that these drugs exist. But in the final analysis, for most of us, most of the time, it isn’t what they are, it’s what we do with them. The power is in our hands!
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This article was last reviewed by on Thursday, 28th February 2008. You can leave a response below.
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http://counsellingresource.com/features/2008/02/28/antidepressant-research-placebo-counselling/
28th February 2008
Thanks Sarah. I think, like you, that this study is incredibly important. If only it will lead to new publication policies by companies and publishers!
Research into the placebo effect I think would be extraordinarily interesting. A study of how people relate to taking their medication and how this relates to outcome would be fascinating, to put it mildly.
The research in psychotherapy, as I understand it - and I don’t make a project of keeping up to date - is that it is the quality of the relationship that heals. Just about any school of therapy gets results, but it is the relationship that differentiates the good from less successful therapists. How this relates to placebo would also be fascinating.
Thanks for a great post.
12th June 2008
Hey Sarah- I was just doing so research and stumbled across your article and found it very empowering! One of my professors was actually one of the people conducting this study. He talked about it one day in class and I found it really interesting! It was great to hear that people have so much control over their lives and way of thinking! I found myself slipping towards depressive thoughts quite often and actually was prescribed an anti-depressant for it, but I found positive thinking and reworking my life habits was much more beneficial!
14th June 2008
I found Evan’s comment especially relevant as far as the quality of the theraputic relationship is concerned. A good one heals.
15th June 2008
Hi Liz - so glad to hear that you found the article empowering! That is just how I reacted to the study…
Yes, Luna and Evan, from my understanding of the research and certainly from my experience, the therapeutic relationship is a, if not the vital factor in the success of therapy. Evan, what exactly did you mean by how this might relate to placebo?
15th June 2008
Hi Sarah,
About talk therapy and placebo. We could look at expectations before meeting the therapist and outcomes (do those who expect it to work get better outcomes?). We could compare one group who just got together to chat with another group who did psychotherapy for the same amount of time. It would be especially interesting I think to study on line counselling where so much of the face to face is left out.
All these would be a way of getting a handle on the role of placebo (expectations) in counselling.
Hope this makes sense.
24th June 2008
Hi Evan, sorry to have taken so long to get back to this that you will probably have forgotten what you were saying!
I am not convinced that the placebo effect can be likened to expectations in “psychological/emotional/spiritual” counselling. When dealing with the non-physical sphere it is obvious that expectations are active factors in recovery - e.g. if you suffer from problems based on low self esteem but you believe that counselling is going to help you then you are already better off than someone who thinks “I’m so useless that it will never work for me”, and the little bit of faith that client has in themselves will work actively to improve the outcome.
I suppose I mean that clients heal themselves anyway, so someone who has a belief in their ability to heal themselves with some help, is going to do that more efficiently and those beliefs are actively working, not passively producing some effect as the placebo does???
I now have the feeling I am not making the distinction clear, although I am quite certain it exists. Maybe it will clarify in further discussion!
24th June 2008
I think your distinction is not clear because of the distinction between active and passive. I doubt this the distinction that needs to be drawn. It is the client who actively does the work in both cases I think.
Hope this makes sense.
24th June 2008
Hmm see what you mean. In an absolute sense it is all active… maybe what I mean is more about relationship! Can you separate out a placebo effect out from what actually happens in a relationship? How?
25th June 2008
Nope, don’t think you can. Everything is in relationship (and this is “objectively” verifiable in my view - in case anyone thinks I am of the ‘everything is subjective’ school).
I think the placebo is (one manifestation of) the strength of relationships (past and present).
Hope this makes sense.
25th June 2008
Yes, I agree, that was the point I was originally making in the post. I do think there is a finer distinction at work in studying placebo effect in relationships - but going after fine distinctions with a mind l(at present) like a blunt instrument is not going to work ;-)
I’m giving up!! :-)