Placebo Effect, Part 2

Not so fast, just how severe is the depression?

Maybe the placebo effect is not enough but can antidepressants actually beat it? Generally, in basic studies of adults, antidepressants are more effective than placebos. However, those who do not trust antidepressants are quick to say that the margin of effectiveness between the two is not enough to outweigh the side effect risks of the actual medicine. Some go so far as to say that a significant portion of antidepressants effectiveness outside of clinical trials can be attributed to placebo effect. This claim is supported by the risk of relapse after initial signs of remission during antidepressant treatment. The argument is essentially that patients feel better due to a placebo effect when first given antidepressants but that this improvement cannot last long term and therefore, the antidepressants are not better than a placebo. Personally, I do not think my research has supported that claim however. In a previous post,  I discussed a study that indicated that patients whose monoamines were more abundant (the main biological effect that antidepressants induce) were less likely to have recurring symptoms of depression after initial remission. Also, I have found a new study that indicates that the more severe the depression, the more the antidepressants outshine placebos. This study does mention that the difference in success between antidepressants and placebos can be almost nonexistent in more mild or moderate cases of depression.

While I have detailed a variety of alternative treatments for depression, the two options that are considered genuinely substantial are psychotherapy and antidepressants. This fact combined with the prevalence of depression as a condition means that psychiatry and psychology are fighting against a formidable foe with limited resources. Severe depression especially can result in death. Furthermore, these deaths tend to be suicides which can have a profound effect on the loved ones of the deceased, resulting in the propagation of depression in even more people. Depression has a certain stigma to it because it is easier to blame on personal weakness than more straightforward biological malfunctions, however, the condition must be seriously addressed. If severe depression really is treated more successfully by antidepressant medications than mild to moderate depression, the treatment of depression can only be improved by that fact and having an effective way to help the severely depressed is indispensable.

You have to have confidence in your placebo or it's unlikely to succeed.

Another thing that is relevant about the placebo effect in depression treatment: while the concept that a placebo effect in the treatment of depression can lead to later recurrence due to inadequate treatment may be a valid complaint, it is my opinion that patients should not let fear of placebo effects reduce their confidence in their medicine. It is unfortunate if a placebo effect that cannot be sustained long term causes the helpful effects of a medication to cease, however, the fact remains that the placebo effect is not likely to be harmful. In the event that one medication no longer works, it can either be determined that the patient might find more long term success with a different antidepressant or perhaps it can even be considered that the severity of that patient's depression is not high enough for the medication to have more than a possibly temporary placebo effect. So long as there are no intolerable side effects, even a placebo-effect induced improvement is better than no improvement at all. In addition, there is another way to improve the long term success of a drug depression treatment and that is by adding psychotherapy to the treatment plan.

Moran, Mark. "Does Placebo Effect Mask True Efficacy of Antidepressants?" Psychiatric News. 2 July 2010. Web. 25 Apr. 2012. <http://pnhw.psychiatryonline.org/content/45/13/17.2.full>.

Sipkoff, Martin. "Antidepressants Work Best For the Severely Depressed." Managed Care Magazine Online. Web. 25 Apr. 2012. <http://www.managedcaremag.com/archives/1003/1003.medmgmt_antidep.html>.

Nauert, Rick. "Placebo Effect Among Antidepressants | Psych Central News." Psych Central.com. Web. 25 Apr. 2012. <http://psychcentral.com/news/2007/08/15/placebo-effect-among-antidepressants/1131.html>.