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.

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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!

All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by on and was last reviewed or updated by Dr Greg Mulhauser, Managing Editor on .

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