Antidepressants and the Placebo Effect

Apr 24, 2014

Discussion by: Red Dog

Antidepressants and the Placebo Effect

In The Folly of Fools Robert Trivers writes: “Depression seems especially sensitive to the placebo effect. Numerous studies have shown that genuine antidepressants account for about 25 percent of the improvement, while the placebo effect accounts for the remaining 75 percent. Believing you are getting something to help you is more than half the battle. After all, depression is marked by hopelessness, and placebos offer nothing if not hope. I always think about this when I am being given an antidepressant. I am told not to wait for an effect for at least three or four weeks—“it needs to build up.” In other words, expect no direct test of utility anytime soon, and the usual rule of regression to the mean—or, things get better after they have gotten worse—will give you all the evidence you later need. In the meantime, get with the program! The most recent meta-analysis (2010) reveals a striking (and very welcome) fact. Placebos work as well as antidepressants for mild depression, but for severe depression, there is a sharp bifurcation: real medicine shows strong benefits and placebos almost none.”

Trivers, Robert (2011-10-25). The Folly of Fools: The Logic of Deceit and Self-Deception in Human Life (pp. 73-74). Basic Books. Kindle Edition.

Since Trivers wrote this there has been another meta-analysis study, concluding more or less the same thing, that antidepressants work virtually the same as active placebos. (Note: an active placebo is something that has some noticeable side effect or requires some effort to use by the patient)

On the other hand there have been responses to these kinds of studies that cast doubt on the conclusions and methodology:

Study shows antidepressants useless for mild to moderate depression? Not exactly.


Do Antidepressants Work? The Effect of Publication Bias

I’ve known some people who swear by antidepressants and others who say they received no benefit from them.

For a change this is a topic where I don’t have a strong opinion. I can see both sides of the argument and I’m curious what other people think; both in terms of other scientific evidence and with personal experience for those who care to share if and how antidepressants did or didn’t work for them.

I will state one opinion up front though: while I’m not sure about the value of antidepressants for any specific individual I do feel that most psychiatrists in the US over prescribe them. It’s their go to drug from what I’ve seen and often based on very minimal amounts of data or patient interaction.

So what do you think? Are antidepressants useful and if so when and why?

One comment on “Antidepressants and the Placebo Effect”

  • I have a depressive illness and have been given almost every antidepressant on the market. For 30 years I felt no benefit from any of them and had begun to consider them a waste of time for me. Then my doctor told me that a combination of two antidepressants had had results in depression in some of his patients who had previously not responded so I thought I would try. I was not confident. What I can say is that my lows are now not quite so low or so long lasting and I am certainly able to lead a more normal life. I am sure it is not totally down to the pills but when I tried to cut them down I became unmotivated and lethargic again. So I am sticking with these pill, placebo or not!

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