International Journal Neuropsychopharmacology September 2002;5(3):193-7
Sugar pills cure depression just as well as antidepressants. What’s more is that sometimes they work better.
According to a new analysis, the majority of antidepressant trials conducted by drug companies have found that sugar pills, or placebos, produce results similar to or better than antidepressant drugs. In one study of 96 antidepressant trials conducted between 1979 and 1996, no difference could be determined between the effects of antidepressants and sugar pills in some 52 percent of trials.
Drug companies are required to conduct two trials that yield positive results before the product will be approved by the Food and Drug Administration (FDA), and reportedly numerous trials had to be conducted before positive results could be shown. The makers of Prozac ran five trials before obtaining two that were positive, while the makers of Paxil and Zoloft had to conduct even more, according to researchers.
In one recent trial, which compared the effectiveness of the herb St. John’s wort to that of antidepressant drug Zoloft, St. John’s wort alleviated depression in 24 percent of study participants compared with 25 percent for Zoloft. However, the placebo cured depression in 32 percent of participants.
The findings do not mean that antidepressants such as Prozac, Paxil and Zoloft do not work, however researchers say that Americans may be overestimating the drugs’ effectiveness. Much of the improvement shown during clinical trials may be due to the close attention and evaluation the patients receive during the study — a phenomenon that does not occur for most patients who use the drugs in everyday life.
Moreover, the sugar pills actually cause changes to occur in the same areas of the brain affected by the antidepressant drugs, according to recent research. It was also found that more patients’ depression is being alleviated due to placebos now than 20 years ago.
Placebos, or pills that have no effect, have long been used by scientists to distinguish the real effects of medicine from the illusive feelings of patients. Often in the field of medicine patients experience what is known as the placebo effect — the feeling of getting better after being treated with placebos.
However, it seems that placebos may actually make a difference in the treatment of depression, as the disease is characterized by how people feel.
Many psychiatrists say that drugs alone will not cure depression. Instead, a combination of medication and psychotherapy appears to yield the best results. Despite this, antidepressants have become the automatic treatment for most cases of depression.
In 2002, there were close to 25 million doctor visits for depression, up from 14 million in 1987. Of these visits, medications were prescribed for nine out of 10 patients, according to recent research.
It is not known how many of these patients received therapy in addition to the medication, however, in 2001 less than one-third of doctor visits for depression were to psychiatrists and two-thirds of them were to primary care physicians. According to researchers, psychiatrists are more likely to administer medicines along with therapy, while physicians, who are less knowledgeable about therapy, are less likely to offer therapy to their patients.
Other studies have shown that in an average eight-week trial, each study participant, whether taking drugs or placebos, is questioned and examined by experts and caregivers for about 20 hours. Comparatively, the average depressed patient likely sees a doctor for only 20 minutes a month.
To add a piece to the puzzle, researchers say that often patients with similar symptoms have different problems with their brain chemistry. The neural mechanisms behind this, and the reasons why antidepressant medications work, are not fully understood.
In one study that followed changes in the brain associated with antidepressant drugs, results showed that many of same changes occurred in patients who took placebos. The parts of the brain that were primarily affected are thought to play a role in mood.
In this particular study, 38 percent of depressed patients got better from taking the placebo, compared with 52 percent from the medicines.
However, once the trial ended and the patients were told what they had been taking, the patients who had been on placebos fell back into their depression. It appears that one’s belief in the effect of antidepressant may account for the improved feeling in patients.
While some say that antidepressants drugs work primarily because of the placebo effect, others believe that the drugs produce an effect of their own. A related study found, through the use of a brain imaging technique, that these medications do in fact produce changes in the brain stem that did not occur in patients taking placebos. However, the effects of these changes are not yet understood.
The analysis led many to say that an integrated treatment that takes into account both biological and mental aspects may prove beneficial in the treatment of depression.