Why Depressed People Improve On Placebo Drugs

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About five years ago on the TV show "60 Minutes," psychologist Irving Kirsch said that the effect of both antidepressants and placebos is about the same for most people.

It is true that many depressed individuals in research studies respond well to placebo (a fake drug), but this does not mean their symptoms were bogus or that antidepressants are useless.

5 Reasons Why People Improve on Placebos

There are several reasons why people’s symptoms may improve while on a placebo. These reasons are being studied by researchers for verification and to learn more about the science behind the placebo effect.

  1. When someone is depressed, their symptoms tend to fluctuate. Some research participants may be getting better on their own.
  2. In research, there may be errors such as errors in the measurement of depressive symptoms. These mistakes may contribute to the appearance of a placebo response where none exists.
  3. The placebo effect, though little understood, is powerful. Our brain seems to have pathways for healing that are activated by expectation. Getting a treatment or medication can set up this expectation. This is similar to the way cognitive behavioral therapy helps people by activating more realistic, positive thought processes.
  4. Research has already determined that the placebo effect creates changes in the brain’s activity. For instance, individuals on placebo pain medication actually produced more natural pain reducing chemicals in their brain. After some Parkinson’s patients received a placebo treatment, their brains manufactured more dopamine, reducing their tremors.
  5. The doctor-patient interactions that occur during drug trials are believed to influence the placebo effect. When depressed people enter a clinical trial, they are going somewhere each week usually after being isolated and lethargic. They interact with doctors and lab clinicians who show interest in their well being. Often, an empathic person meets with participants one-on-one to find out how they are doing, more interaction that most people get when receiving medications from their doctor.

So in a research trial, an antidepressant doing as well as a placebo does not mean the antidepressant is doing as well as nothing. The expectation effect, brain changes, and face-to-face interventions that come with placebo use are each something. Understanding these somethings may improve all our lives.

Sources: Child Mind Institute; Columbia Psychiatry
Photo credit: Simone / flickr creative commons

 
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