There’s a pill for almost any
lifestyle problem extant in 21st Century America, from smoking and dieting to
sleeping and loving. The question is: Do
the lifestyle pills work, and, if so, for how long? The drug industry certainly is paying attention;
they spend billions of dollars annually including placebos in their studies to
“prove” to the United States government that any positive change after taking
their medication is attributable to the medicine and any negative change must
be due to some non-medication influence.
Today, let’s address depression
and anti-depressant pills. Tofranil, one
of the first anti-depressants in America, was approved for sale in 1959. So, medication for depression has been
available to the public for almost 60 years.
Anti-depressants certainly should have proven their worth by now. But despite drug companies efforts to prove
otherwise, many scientists believe that many anti-depressant and other
pharmaceutical lifestyle “cures” amount to little more than transitory placebo
effects.
To underscore the questionable
utility of anti-depressants, consider this:
The explanatory power of placebos has been increasing over the
years. In fact, the placebo response
for anti-depressants was twice as strong in 2005 than it was in 1980 (Rief,
2009). Moreover, that “placebo drift”
had been found for other types of medications as well (Captchuk & Miller,
2015).
No one has been more outspoken in
cautioning about anti-depressants than Irving Kirsch (2014). He noted: 1) that all anti-depressants are
said to benefit patients via their influences on neurotransmitters and 2) that
all anti-depressants are fairly similar in their efficacy. Wondering why the similar effectiveness, he
investigated the serotonin neurotransmitter and found that some anti-depressants decreased the
chemical, some increased it, and some had no effect on it whatsoever. On the other hand, the placebo effect was
obvious and similar for all of the anti-depressants.
Since a properly structured drug study requires that subjects not know
whether they have been given the investigational drug or the placebo, he was
surprised to discover that 89% of patients getting the drug guessed correctly
that they were not given the placebo (Rabkin et al., 1986). And that fact certainly undermined those studies' scientific integrity and validity
After enumerating a host of
potential side effects of anti-depressants, including but not limited to sexual
dysfunction, long-term weight gain, insomnia, nausea, diarrhea, withdrawal
symptoms, suicidal ideation, stroke, and death, Kirsch concluded: “When
different treatments are equally effective, choice should be based on risk and
harm, and of all of these treatments, antidepressant drugs are the riskiest and
most harmful. If they are to be used at all, it should be as a last resort,
when depression is extremely severe and all other treatment alternatives have
been tried and failed.”
Please understand that I am not
saying anti-depressants never should be used.
I basically agree with Kirsch, however, that the pills are an option of last
resort. Depression usually can be
ameliorated or even cured by lifestyle changes involving some combination of
the health-promoting factors that I emphasized in my book: changes in the
approach to one's cognitive-emotional perspective, interpersonal relationships,
physical activity, diet, work, and relaxation-recreation practices.
References:
Kaptchuk, T. & Miller, F.
(2015). Placebo effects in medicine. New England Journal of Medicine, 373:8-9. DOI: 10.1056/NEJMp1504023
Kirsch, I. (2015). Antidepressants and the placebo effect. Zeitschrift für Psychologie, 222, 3,
128-134. doi: http://dx.doi.org/10.1027/2151-2604/a000176
Rabkin, J., et al., (1986). How blind is blind? Assessment of patient and
doctor medication guesses in a placebo-controlled trial of imipramine and
phenelzine. Psychiatry Research, 19, 75–86
Rief, W., et al. (2009). Meta-analysis of the placebo response in
antidepressant trials. Journal of
Affective Disorders, 118, 1-2, 1-8.
DOI: http://dx.doi.org/10.1016/j.jad.2009.01.029
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