Alert – The placebo effect and antidepressants

February 26, 2008

Five centuries ago, the Swiss alchemist and physician Paracelsus (1493-1541) wrote: “You must know that the will is a powerful adjuvant of medicine.” In a nutshell that sums up the effect that placebos can have on our bodies: they can effect change without containing any active chemical ingredients that could medically make a difference to the state of our health, and yet they often can provoke therapeutic effects – both positively and negatively – when administered to patients.

Researchers now believe that belief in the placebo as being part of a curative treatment seems to stimulate the body’s own healing mechanism – if we believe it is doing us good, then it is. Our belief stimulates certain bio-chemical responses and reactions and increases our ability to initiate our own healing process.

The term placebo literally means “I shall please” and was used in mediaeval prayer in the context of the phrase Placebo Domino (“I shall please the Lord”). Much later, during the 18th century, the term was adopted by medicine and was used to imply preparations of no therapeutic value that were administered to patients as “decoy drugs.” Over time it became recognised as having an important role in the therapeutic treatment of patients and in more recent studies, the placebo effect was estimated at 60% of the overall therapeutic outcome. In a recent review of 39 studies regarding the effectiveness of antidepressant drugs, psychologist Guy Sapirstein concluded that 50 per cent of the therapeutic benefits came from the placebo effect, with a poor percentage of 27% attributed to drug intervention. Now an even more startling study by the FDA has revealed that the new generation of SSRI anti-depressant drugs are even less effective than Sapristein’s study showed.

I have a vested interest in the subject as I have been treated for depression since my teens and now 50 years on have tried many drugs, therapies and natural alternatives and finally discovered that I just have to learn to recognise it and live with it as for me nothing has proved effective over the long term and the side effects of antidepressants have seriously affected both my creativity and natural personality. Depression is a serious medical illness caused by imbalances in the brain chemicals that regulate mood. I am certainly not alone with my experience of depression as it affects one in six people at some time during their life, making them feel hopeless, worthless, unmotivated, even suicidal.

Doctors measure the severity of depression using the “Hamilton Rating Scale of Depression” (HRSD), a 17-21 item questionnaire. The answers to each question are given a score and a total score for the questionnaire of more than 18 indicates severe depression.

Mild depression is often treated with psychotherapy or cognitive-behavioural therapy to help people to change negative ways of thinking and behaving. For more severe depression, current treatment is usually a combination of psychotherapy and an antidepressant drug, which is used to normalize the brain chemicals that affect mood.

Antidepressants include “tricyclics,” “monoamine oxidases,” and “selective serotonin reuptake inhibitors” (SSRIs). SSRIs are the newest class of antidepressants and the FDA (Food and Drug Administration) in the USA has reported on both published and unpublished trials on SSRIs submitted to them during their licensing process. The findings have rocked the medical world as it has indicated that these drugs have only a marginal clinical benefit. On average, the SSRIs improved the HRSD score of patients by just 1.8 points more than the placebo. The most effective clinical rating for SSRI’s was for severely depressed patients and the FDA again reported that this reflected a decreased responsiveness to placebo rather than an increased responsiveness to antidepressants. I am not saying don’t take antidepressants, I have done so myself, but I am saying think before you go down the drug intervention route.

That ‘will’ that Paracelsus referred to that certainly has a powerful role to play, particularly in the area of whether we regard our treatment positively or negatively, regardless of what it contains. Positive or negative thinking seems to be a decisive risk factor for every treatment, perhaps even more important than medical intervention, so looking at our attitude to life could be the first place to start. Research clearly indicates that positive thinkers live on average 6 years longer than those who always respond negatively to life – it’s not about being a ‘Pollyanna’ and forever looking on the bright side but it is about taking those lemons life hands out and making some lemonade, or in my case lemon curd, rather than leaving them in the bowl to rot and decay.


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