Depression and the Placebo Effect

As we all know, the incidence of depression worldwide is an increasing problem. We are aware about the problem, but few actually realize the way depression is approached is largely wrong. Antidepressant use is widespread as there is an increasing amount of people using them, among all age groups. I recently saw a reportage on 60 Minutes that intrigued me. Even though it is from 2012 the matter in question is very much still controversial. To what extent are antidepressants used inappropriately? Do people with mild or early forms of depression actually need them? These are questions that require research.

 

Watch video – Treating Depression: Is there a placebo effect?

 

This 2012 60 Minutes reportage is about an ongoing medical controversy, regarding antidepressant use and abuse. Irving Kirsch, a psychologist, researcher, and associate director at Harvard Medical School’s Placebo Studies Program, questions the proper use of antidepressants, as he describes evidence in his studies that suggests patients with mild to moderate depression could avoid their intake, since the effect they have is seemingly no greater than that of placebo medication. The repercussion of his statement reverberates broadly among the scientific community, as 17 million Americans, many as young as six years old, currently take antidepressants, and the pharmaceutical industry profits 11.3 billion dollars from their sell every year. He acknowledges that patients taking antidepressant drugs have evident clinical improvement, yet he attributes this recovery to the placebo effect, which is an improvement in signs and symptoms by unknowingly consuming a dummy pill that does not possess any chemically active ingredients. The video describes previous placebo research done in patients with different ailments, which include irritable bowel syndrome, strain injuries, ulcers, Parkinson’s disease, and traumatic knee pain. Professor Kirsch even describes a clinical trial in which a number of patients underwent arthroscopic knee surgery while others merely had trocar knee incisions done to them. The results were staggering, as patients who had the placebo procedure referred greater improvement than those who had the traditional surgery. He adds that the placebo effect is not solely in the mind, as not only symptoms like pain have an improvement (as evidenced in brain neuroimaging), but also clinical signs of blood pressure and heart rate tend to normalize in these patients, and the approach of the clinician also has a pivotal effect in the result of the placebo treatment. The more understanding, communicative and humane the clinician is, the better the results obtained from this technique. Finally, he recognizes there is a clear difference in the effect of antidepressants in cases of major depression, but for the majority of patients, who don’t have this grave condition, more can be done aside from giving antidepressants. Opponents of these studies argue that individual cases must also be taken into consideration before concluding the inefficiency of antidepressants in mild to moderate cases of depression, as in clinical practice patients will show evident improvements due to the effects of the antidepressant, preventing further worsening of their condition.

My initial reaction to this video is moderate, as I agree with professor Kirsch’s studies to only a certain extent. I believe his findings could make many patients who actually need the antidepressants avoid their use, which bringing about negative consequences in their clinical progress, leading to chronicity and even suicide. On the other hand, I believe there is over medication of antidepressants nowadays. Even in mild cases of depression, psychiatrists tend to give antidepressant medication, which might discourage patients from finding other ways to overcome this terrible impairing disease. I think psychiatrists should first give the opportunity to patients to find other alternatives to improve their life problems, by proactively making clinical referrals to other specialists, like psychologists and therapists, even mindfulness experts, and work in an interdisciplinary manner with them.

Another important point I would like to mention is the intrinsic positive effect of antidepressants in neurological functioning. There is extensive research that suggests that these medications are neuroprotective and even neurogenerative, which would be of enormous benefit to these patients.

On the other hand, there is a social aspect of stigma towards the use of antidepressants. Peru, where I come from, has much greater stigma on the use of antidepressants than the United States, and people tend to very easily avoid the use of these drugs. I believe that making public the use of placebo medication for depression might enforce the stigma if not properly exposed to the public.

What could we do at OSU to improve the approach to depressed students? – If I could make public policy, I would make mental health providers be more proactive in searching for depressed patients, at schools, universities and the workplace. There should be better screening for depression. For example, I would like to see a program at The Ohio State University that would engage in calling students whose grades are going down, especially those who are also missing class, to ask them for the reason of their academic troubles, and try to find a solution which could include psychological consultation at the university’s Wellness Center.

Angelo Juarez

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