As we've discussed, biomedical therapy is very popular in the treatment of many disorders, especially depression. Drugs such as Prozac and Zoloft have become common in our vernacular. Often people seek treatment and are prescribed an antidepressant. Sometimes these are also used with psychotherapy.....other times not.
In this article published in January 2010, Sharon Begley raises the question of whether or not antidepressants work. Moreover, she explores the placebo effect in detail, arguing perhaps that it may be all we need to cure depression.
Please read this article and comment by Thursday 3/31 before class. Consider the following questions when drafting your response:
- What is the placebo effect and how does it impact treatment of depression?
- How do you feel about the FDA requirements from clinical trials in approving drugs?
- How do antidepressants affect people with mild, moderate, or severe depression? Why do you think there is a difference among the three?
- If antidepressants are not the answer to depression....what is?
http://www.newsweek.com/2010/01/28/the-depressing-news-about-antidepressants.html
Begley, S. (January 29, 2010). The depressing news about antidepressants. Newsweek. Retrieved from:
http://www.newsweek.com/2010/01/28/the-depressing-news-about-antidepressants.print.html
I think this article really highlights how statistics and results of experiments can be skewed in any way to present a convincing argument. As we’ve discussed, framing information in a certain light can sway viewers or readers to believe one thing or another. Another thing we’ve seen throughout the course of the year is how the placebo effect plays a role in curing illnesses, reducing addictions, etc. I certainly do believe that people will report reduced depression from taking only a placebo pill, but an explanation of this requires looking at the situation from a biopsychosocial approach.
ReplyDeleteIf a client goes in with a high expectation of reducing their depression, the chances are definitely much higher that they will see a decline in their symptoms after taking any pill, whether it is an antidepressant or a placebo. Expectations really are everything – if someone truly believes that the medication will not be effective, it will not produced the desired results; however, if someone is convinced that the depression will be relieved, he or she will try to make the medication seem effective. I also see cognitive dissonance coming into play here. If our attitudes and our behaviors are not in line, we will adjust the attitude to match the behavior, or vice versa. In this case, if a client chooses to maintain the attitude that antidepressants are helpful, he or she may put on a front and force himself or herself to become a more positive person. In instances such as these, it is not actually the medication doing the work, but rather the person adjusting their attitudes and behaviors on their own. Another perspective which needs to be considered is that of who is administering the drugs or placebo. When clients receive medication from a doctor who they supposedly confide in and trust, they always want to believe that the doctor knows what’s best. Who would want to admit that their doctor did not prescribe them an effective medication? We tend to believe whatever doctors say, as we feel that they are far more knowledgeable in their area of expertise than we are.
The article mentioned that in Britain, the agency that assesses which treatments are effective enough for the government to pay for stopped recommending antidepressants as a first-line treatment, especially for mild or moderate depression, indicating that they are less effective for less severe cases. I agree with this argument, as many times people will develop mild depression from one single traumatic or harmful experience. For example, if someone becomes depressed over the death of a spouse, I don’t feel that prescribing antidepressants is the best way to go about the problem. Being upset over the loss of a loved one is always a tough experience, and I think that the only way to come out of depression is through the practice of healthy grieving and conversation with family members. On the other hand, for a client who has been isolated, withdrawn, and depressed since childhood, antidepressants would probably be more effective. In this case, there is no one single cause of depression that can be pin-pointed. Depression is such a wide-scale disorder, (affecting all ages, races, and places) that statistics involving it should not be so generalized. Each case much be evaluated individually to obtain the best possible course of action.
This article seem to hit home on the placebo effect. Not only that, but the article portrayed the way we tend to argue for or against something based on our own experiences. The article was convincing enough to portray that placebo effect has impact on the treatment of depression The placebo effect is a false treatment, such as a pill, having no significant effect on participant. This effect impacts the treatment of depression because of the thoughts, experiences and expectations we have of the treatment, or doctor itself. If you are given a placebo pill to help with depression and we take it with the mindset that I am going to overcome it once and for all then chances is that the outcome will be the same if not similar to what you expected. This goes the other way too. If you go into this whole treatment thinking the pill will never help me and will not have any effective on me then chances are the pill will not produce and help to your expectations.
ReplyDeleteWe also can tend to have the mindset that things will work out better when our doctor or physician is nice, sincere, and caring. As we talked about in class today, we don’t want to put the blame for a pill/ treatment being subscribed to u that does not in reality really help or work. I know I tend to go along with whatever the doctor says I have to take, get done, check up on without questioning it. This is sometimes where we tend to run into trouble. We tend to just think everything will and can help us, without asking questions and being aware of what’s to come. I never thought of some of these treatments just being there for people to just “make money” off of them You would think someone would be really aware of this, but if I remember correctly the article states that some (not all, obviously) doctors are unaware of such things. We have to remember our physicians are not psychiatrists and don’t understand the in depth topics on these treatments. Physicians as well as patients just see these pills as the easiest treatment to do. They require less time than any other treatment such as psychotherapy.
Antidepressants could affect people who have mild, severe cases of depression differently. Each case of depression should be looked at individually because there are so many different causes of depression that you cannot say that one type of therapy is best for a certain type of depression. We all have our own ways of healing. I think the best way to treat depression is by being able to talk it out. Being able to talk through troubles could be the hardest, most grueling process, but in the end is worth it. It’s the case of mind over matter. We need to look at each case with different perspectives and ways to help. No one person is the same and thus, no one person should be treated the same.
Imagine if you were a patient with depression and you were given a pill which was said to help with your depression, but you later find out that it was a placebo pill? Is this what's going to happen in the future? If people start accepting the authors opinion, this may one day happen. Personally, after reading this article I was pretty convinced that a placebo pill is close to as affective as a real antidepressant pill.
ReplyDeleteThe placebo effect is experimental results caused by expectation alone. It includes any effect on behavior caused by the administration of an inert substance, such as a pill, or condition, which the patient assumes is an active agent. The placebo effect impacts the treatment of depression because it causes a person to believe in the pill they are taking. They expect that this pill will reduce their depression, so they try to make the medication seem effective and display symptoms of recovery.
I think it is crazy that the FDA requirements in approving drugs is only based off of TWO well-designed clinical trials that show that the drug is more effective than the placebo. Even if many more studies show no such effectiveness , the FDA still approves the drug. Maybe if the FDA is more strict in approving the drugs, the drugs that are given to depressed patients may be more effective.
I think that no two people experience the same form of depression. Whether a person is affected by mild, moderate, or severe depression, every person will being affected by antidepressants differently. Some people may experience improvement by drugs, while others may experience improvement by therapy. Depression is such a broad disorder experienced by so many people that I don think there is one answer to depression. Therapy may work for some, while antidepressants may work for others. But most important to recovery is identifying the problem and being open to help!
The placebo effect has to do with the idea of a self-fulfilling prophecy. In this case the placebo effect was mentioned and experimented with in the article. Patients, who did not actually receive legitimate anti-depressants, but rather “dummy bills”, experienced almost the same percentage at getting better than people who took the real drug. This is astounding evidence of the placebo effect at work. Because people believed in their minds that they were getting the real drug, they felt improvement and were able to be pulled out of their depression. It was all in their mind. They thought they were taking drugs and therefore their mind allowed them to believe they were being lifted out of depression because of these drugs, when in reality they were taking nothing more than dummy pills. The article provided valid statistics to show that there was only a miniscule difference between those who received the actual drug and those who received the placebo. From a personal opinion, I would say that all doctors should first try prescribing their patients a placebo bill before opening them up to the real thing.
ReplyDeleteI never knew that the FDA had such a lenient policy in approving drugs. Knowing how easy it is to get a drug approved is actually quite scary, and makes you question everything else they approve. It makes you wonder how many of these so-called “miracle drugs” actually work, and how many of them are all part of the mental game. Are people suffering withdrawal symptoms from these drugs for no reason? Can these psychological disorders be treated with merely a placebo and some therapy? Defenders of the drug argue that the FDA would have never approved an ineffective drug, but it is highly doubtful that they know how relatively easy it is to get such drugs clinically approved. It is astounding that the FDA only requires TWO well-designed clinical trials showing a drug is more effective than a placebo. It does not matter if there are 100 trials proving that the placebo is just as effective as long as there are two valid trials showing it is not. Based on this policy it is relatively simple to get such drugs approved.
People with mild depression do not need to be put on medications. I recall someone’s past blog discussing the effects that antidepressants have on people. People on these drugs have committed some serious crimes and have done crazy, harmful things they usually would not have even considered. In one case it described a boy who stopped taking his antidepressants and went out on a rampant shooting in his school. Someone with mild depression would be ruined by the withdrawal effects of these drugs. A person with moderate depression can go either way, but personally I believe the drugs also do them more harm than good. For these people the drugs should be nothing more than a last resort because they will also suffer from the negative withdrawal symptoms. Antidepressants may need to be supplied to people with extreme and severe depression as there might be no other way to cure them. However, these patients should be warned that they will have to take the drugs for the rest of their life. Someone with severe depression would suffer the most serious and intense withdrawal effects, and they should be aware of this before being given a prescription for the drugs.
( it wouldnt all fit in one post)
ReplyDeleteAntidepressants are not the answer to depression, but there are other, more effective methods of treatment. As the author talked about in her article, psychotherapy can be extremely effective when treating depression. Having someone merely see a counselor, attend family sessions, and have successful therapists can sometimes do the trick. Drugs should be used as a last resort only. Psychotherapy can be extremely effective when dealing with people who only suffer slightly from the disease. Having a therapist can be exactly what they need. If this doesn’t work, there are other methods of treatment such as behavioral therapy and cognitive therapy. People should take methods of treatment from the learning and psychoanalytic perspective rather than heading right for the biomedical treatment. Of course this is not for all cases, as those with extreme depression might need to be prescribed the drugs. However, I strongly believe that they should also be given therapy and guidance to help them overcome depression.
Nice responses so far! Alyssa, great points. I'm happy you had so much to say! For future posters...consider this question as well... Have you ever experienced a placebo effect? i.e. has just the thought of doing something helped improve a situation (physical pain, emotional, etc.)?
ReplyDeleteI know I have definitely been tricked by the placebo effect. I once had a headache, and meant to take some motrin. A little while later, my headache went away and I felt fine. I later remarked to my mom how well the motrin had worked - when she reminded me that I never taken it at all. So, I know first hand how effective the placebo effect can be! Maybe the placebo effect can be as effective with depression.
ReplyDeleteThe placebo effect is defined by the measurable, observable, or felt improvement in health not attributable to treatment. It applies to depression because if a patient takes a pill that they assume will cure them, they may begin to act that way. They may begin to exhibit the symptoms of someone who is not suffering from depression. One quote that really blew my mind was that, "About 82 percent of the response to antidepressants—not the 75 percent he had calculated from examining only published studies—had also been achieved by a dummy pill." This shows what little effect antidepressants can really have.
I think the FDA could do a much better job with their requirements from clinical traits in approving drugs. Right now, they only have two requirements for a drug to be approved. Clearly, the drugs the FDA are approving are not being as effective as they should be. If the FDA has even ten requirements for drugs to be approved, maybe the drugs could help their patients more.
I feel like categorizing depression into "mild, moderate or severe" is like categorizing a gunshot as "mild, moderate or severe." Either way, it is going to impact your life and make you very uncomfortable. Either way you are going to be looking for help, as soon as possible. That said, each person who is depressed will respond to antidepressants or the placebo effect differently. There is no way to tell how any given person will react to medication or a placebo - the only way to find out is to test it. Since antidepressants are not the best answer to depression, perhaps the best form of treatment is either the placebo effect, or group therapy, or family therapy. I think it depends on the person. Each person will respond to each treatment in different ways.
Like Katie I have experienced the placebo effect with my headaches. I always mean to take an Advil, but sometimes I forget. Thirty minutes later I think to myself wow the Advil worked really fast, but I had not even taken it yet. The placebo effect is results based on solely expectation. It is when a doctor gives a patient a pill (the patient thinks they are getting the real treatment), but the pill actually does nothing to help the patient. The placebo effect works with antidepressants. Patients with depression who are taking the pills with display stages of recovery when in fact the pill actually is not leveling out their levels of serotonin and norepinephrine. The placebo effect causes people with depression to think they are getting help from the pill but really they are not.
ReplyDeleteI thought it was crazy how close the recovery results were between the people who took placebo pills and those who took the actual medication. Why wouldn’t doctors not give patients the actual medication and try out the placebo first. This way the patients would not have to go through any of the harsh symptoms that are caused from the real pill. When reading this article I saw how easy it is to get a drug approved by the FDA. The FDA only requires two clinical trials showing that the drug works better than the placebo that’s nothing!
Antidepressants will affect people with mild, moderate, or severe depression all differently. Each patient should be looked at on an individual basis so that they can receive the most effective treatment. I think people with mild depression do not need antidepressants they can go to therapies and talk out their issues. People with moderate depression probably do need antidepressants, but in small doses combined with therapy. And then people with severe depression most definitely need antidepressants. I do not think that antidepressants are the answer. I think that going to group therapies, family sessions, or individual therapies is the best answer. People with depression should get help and talk out the issues they are having before they decide to take antidepressants.
I thought that it would be interesting if I went through and answered these questions before I read the article and then again, after I read the article. (That is why my blog is in question/answer form.) All of my answers stayed the same from before and after I read the article except for number 2. I had no idea what the FDA’s requirements were, so when I went through the first time all I wrote was that I agree with their testing(I had no other substance to back up my thoughts—I was then proven wrong after reading!)
ReplyDelete1. What is the placebo effect and how does it affect treatment of depression?
o The Placebo effect is when a person’s health gets better from non-medical means when the patient thinks that they are receiving medical help. An example of this could be a person receiving a pill that does absolutely nothing for them health wise attributes their getting better to what they have been given. However, the pill has not done anything for the patient and the only reason he/she thought she got better in the first place was that she was receiving the treatment. It is almost a reverse psychology of sorts. The patient does not know that the pill really is not helping them, but because they think it is helping them, they start to feel better and better, healthier and healthier.
2. How do you feel about the FDA requirements from clinical trials in approving drugs?
o I do not agree with the FDA requirements for approving drugs. Their policies are so relaxed, and it seems to me that it should be just the opposite!! If it is so easy for these drugs to be approved, then I wonder how easy it is for other drugs to be approved…
3. How do antidepressants affect people with mild, moderate, or severe depression? Why do you think there is a difference among the three?
o I think that antidepressants have the most affect on people with severe cases as well as moderate cases of depression. Whenever there is an issue that bad, I think that if medical steps can be taken to improve the situation, they should be. This is why I do not think that a doctor should hold back in prescribing antidepressants for people who are suffering from severe cases of depression. I am a little on the fence as to whether or not I think that people with moderate cases of depression should receive antidepressants. If the doctor thinks that a patient could take a turn for the worse then go for it, but if a patient is coming out of a deep state of depression and they have been getting themselves out of it without any medical assistance, then the doctor should let them keep doing what they are doing. In addition, in no way do I think that people with mild depression should receive antidepressants! Maybe they are just going through a rough patch in their life that will be over soon enough, or maybe they are just have difficulty coping with something that has happened to them. Either way, I think that people with mild cases of depression should see a psychologist/therapist and try to work their problems out that way rather than taking pills.
The placebo effect is evidence of the power of the human mind and willpower. If you believe enough in something, it usually comes through for you...or at least, you perceive that it comes through for you. I'm not at all surprised that a placebo can have the same results as the highly effective antidepressants that are usually prescribed as the first step of treatment for psychological disorders.
ReplyDeleteKnowing the impact that placebos alone can have on symptoms of disorders, I am surprised that the FDA does not have a more rigorous and intense trial period for drug therapies. I think that drugs are the easy answer for most patients because it seems like a tangible fix for them, whereas psychotherapy may hold extremely necessary and important benefits and reductions of symptoms but not the kinds of physical symptoms addressed by medications. The FDA really should remember this and consider that because medications are the first step of treatment for many patients, it is incredibly important that their medications are completely sound and 100% tested and proven to benefit parients. Like someone else asked, why won't psychiatrists prescribe placebos more often, instead of risking patients' already unstable health with drugs that the FDA may have carelessly approved? Antidepressants have proven successful, but placebos have proven almost as successful! I say that it's worth a shot, if it means avoiding some potentially unwanted and unanticipated reactions to an actual antidepressant medication because everyone's bodies and systems react to the same medications in different ways.
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ReplyDelete4. If antidepressants are not the answer to depression...what is?
o I do not think that antidepressants are always the answer to depression. I know that that is a very vague statement, but I really believe in it. I think that doctors are often too quick to think through a patient’s diagnosis and the easiest way to get them to leave the office satisfied is by giving them an antidepressant pill. For the more serious and severe cases I definitely believe that a patient needs an antidepressant along with therapy or some other medical attention with a highly trained medical professional, but there are other ways to go about solving the problem for people who are not in a deep state of depression. I am and have always been a big believer in mind over matter. I apply that to my daily life (when I am running and get tired), and in a way I feel like that can be applied for people who do not have severe cases of depression. (Although this brings another issue—there needs to be an operational definition for severe and mild depression.) I think that the placebo effect could/can make a big difference in a person’s recovery. If they think they are getting better, then they will have a positive mental attitude, and having a positive mental attitude is the ideal situation for recovery. It is like a cycle—one thing happens and it just keeps on getting better (healthier and healthier).
I found this article extremely interesting because it talked about a subject that is rarely brought up. The placebo effect, or the medical benefit a person gets from an inert pill or other sham treatment, is a topic that can be easily debated. It is hard to come up with a set opinion either way on the topic of whether depression is treated completely by antidepressants or the placebo effect. Personally, I think it is a combination of both treatments depending on the severity of a person’s depression. I agree with the author’s opinion that the placebo effect can get a person very far in recovery, but if the person had a very severe case of depression, the placebo effect alone will not bring a person to full recovery. I do, however, firmly believe in the placebo effect. I think it is a necessity in order to recover from an illness, but more importantly depression. Since depression deals with a person’s mood and attitude, believing that they are getting better is a necessity to a person’s success in recovery. I think that I have had firsthand experience with the placebo effect, but on a more minor scale. After having my third surgery in three years, I was very discouraged emotionally about my future success on the soccer field. I could have easily just gave up and threw my entire soccer career away, but instead I believed in myself and my skills and the fact that I could get better. Without this mindset, I would never have been able to improve the situation I was in a continued to pursue my soccer career. Yes, I was also doing the physical treatments of physical therapy and extra training to get back in shape, but emotionally I needed to be able to believe in what I was doing and that it would get me back to where I was before the injuries. This is an example of why I think the placebo effect plus the antidepressant drugs are necessary in order to fully recover a patient from depression and also avoiding relapse. I also believe that major publication of this study, however, will essentially ruin the capability of the placebo effect. Patients who receive drugs from doctors to treat their depression will start to second guess the treatment of that drug because they will constantly think that they have the inert pill instead of the real one. This worrying will result in fewer patients recovering from depression because the placebo effect will lose its effect. In conclusion, I strongly believe in the concept that people need to believe in the effectiveness of a treatment in order to fully recover.
ReplyDeleteI thought this article was super interesting and shed light on some little known facts about anti-depressants. There is no doubt that self-fulfilling prophecy and the placebo effect go hand in hand with depression. The statistics about depression and the placebo effect in the article shocked me. They really supported how important a positive and optimistic attitude are during treatment for depression. People often seek anti-depressant medication as a quick fix for their depression without researching the drug they're taking, but they're told it will "fix" their problem. With the expectation that the tiny white pill will rid them of their depression, people begin to feel better. This placebo effect can also have the opposite reaction. If someone is prescribed an anti-depressant but convinced it will not rid them of their depression, they may not get better. The success of anti-depressant treatment can be attributed to the patient's self fulfilling prophecy, whether it be a positive result or a negative one. The article puts depression on a small spectrum. I don't think mild, moderate and severe can really capture the truth about depression, as it is such a personal disorder. I think that treatment and medication should be specific to the patient, as people often experience treatment and depression differently. I don't really think there is one answer for depression. I think the success of the treatment or medication often relies in the hands and attitude of the patient. Like Nicole said, I firmly believe in mind over matter and the power of positive treatment. I think the effect therapy has on curing depression often goes unstated. Sometimes just vocalizing the feelings and problems can help solve them before jumping to medication.
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ReplyDelete"About 82 percent of the response to antidepressants...had been achieved by a dummy pill." This shows, as does all other evidence in the article, that antidepressants make little chemical changes to our brains; instead, they play mind tricks on us. What I found most interesting, though, was one of the points the article arrived at in the end: this may not be a bad thing. The placebo effect ties in strongly with the self-fulfilling prophecy in that because we expect to be affected by a drug, we will experience that effect even if the drug we receive is really not the drug, but some sort of "dummy pill." For many of those suffering from depression, antidepressants seem to be the only hope and seem to have so much "science" to back up their effectiveness; thus, patients put much of their confidence in them. Because of this great hopefulness and this high level of confidence, patients may think they are feelings the effects of a drug when they, in fact, may have never taken that drug. As a result, the effects of placebos appear to be relatively on par with the effects of real antidepressants.
ReplyDeleteOf course, this is alarming. Not only do antidepressants come with monetary costs; they also come with side effects. Why, then, if they essentially don't chemically work, should patients have to endure such difficulties?
I definitely saw the FDA as a huge culprit in the article for letting ineffective antidepressants be released and sold. Only TWO clinical trials are needed to get a drug approval? Further, the requirements for "success" of these trials do not even demand truly significant change, just statistical significance.
Though antidepressants have proven more effective for those suffering from very severe depression (this is how certain trials were made to seem more successful than they truly were), those suffering from mild to moderate and even to somewhat severe depression seem to reap no benefit from these drugs. Since antidepressants aim to make chemical changes to the brain, I think they are more successful with very severe patients simply because those patients have the most chemical imbalances that need to be changed. Less severe depression patients may not have such significant chemical imbalances in their brains, and as a result, the antidepressants have no way to be effective. Instead, psychotherapy is presented in the article as a welcome alternative to antidepressants for those suffering from mild to moderate depression that has more success and results in far fewer instances of relapse. I definitely understand this support for psychotherapy, because I think it is more patient-specialized, which is something drugs are usually not. (Even in the case where researchers tried to custom-make drugs for patients, its effectiveness was not fully proven.) Patients need to get at the root of their problems, which could be based on past experiences or rooted in environmental or cognitive factors. Essentially, to use only drugs without therapy would be to ignore every psychological perspective other than the biological one. Of course, I'm not completely erasing drugs from the equation -- in a lot of cases, it can be helpful to use a combination of drugs and therapy.
To go back to the placebo effect, the results of psychotherapy are actually put on par with placebo effects. I don't think this diminishes the perceived effectiveness of psychotherapy; instead, I feel that it makes a statement for the power of the placebo. Like a lot of you, I've experienced the placebo effect in that I often look for expected results after I drink coffee (feeling hyper/energized) or take some Mucinex (my nose is suddenly less stuffy!).
it wouldn't all fit...
ReplyDeleteWell, a lot of times I've actually been drinking decaf without realizing it; I'm also pretty sure Mucinex doesn't work too well after it has expired. But like the article says: we can use the placebo effect to our advantage. Those suffering from depression may not have to suffer through the side effects of drugs if placebos produce the same results.
Since depression deals with a person’s mood and attitude, people need to believe they should be getting better in order to actually get better. This is the same concept as why a person has to be open to therapy in order for therapy to help them. This is why the placebo effect works. The placebo effect is when a false treatment that should have no significant effect on the person (such as a sugar pill) makes the person feel better. The depressed person knows they are depressed and seeks help. They are given sugar pills under the guise of antidepressants. The person is ready to feel better and thinks the pills are making them better so they start to feel better. The placebo effect might even just do one little thing that triggers a cycle of good things to make the person healthier. An example of this would be that a person took a placebo which they thought would give them more energy so they decide that they feel good enough to get some exercise. The exercise then produces endorphins, giving them a “runner’s high” making them actually start to feel happier. Since they are happier, they will start feeling more optimistic in general and get better.
ReplyDeleteLike Bridget, I have often been fooled by the placebo effect in drinking decaf coffee. If I have to stay up late to finish a paper or study, I often have coffee. I drink it and feel energized, but really its decaf coffee. My great aunt also experiences the placebo effect when she takes pain medication (which takes about 10-20 minutes to kick in). She's complaining about back pain or something so she takes the pain medication and literally 3 minutes later she "feels so much better."
I’m surprised that the FDA does not mandate a more intense trial period for drugs before they are approved. I would think that they would consider the success of the placebo effect and therefore wait to see all the side effects of the drug before making it available to people. Requiring only two clinical trials showing that the drug works better than the placebo before approving the drug doesn’t seem like it would benefit the people being prescribed these medications.
I think everyone with depression should give therapy a try first before turning to antidepressants. Of course, if you have someone that is so severely depressed that they are a danger to themselves or others, they need to try drugs and possibly be admitted into a mental hospital for constant supervision. I think people with mild depression should definitely be treated using psychotherapy, instead of psychopharmacology. I also think that if doctors prescribed their patients a placebo before trying the actual drug, people may get better on their own without the drug.
The placebo effect is a huge concept when dealing with antidepressant drugs. If the patient thinks that he or she is taking the drug, they are more likely to experience an improvement in condition because they feel that the drugs are helping them. I thought it was interesting that the author of the article pointed out that though the recorded difference between the effects of placebos and the real deal are minuscule, it could be even smaller than we think because of self-fulfilling beliefs. Because the procedures are double-blind, neither the patient nor the doctor know whether or not the patient has been given the real drugs. If a patient begins to develop "side effects", they immediately begin to believe that they have been given the actual drug, and therefore believe that they are going to improve. At the same time, you could argue for the placebos that knowing that it's possible that side effects are associated with the drug, a person could begin to show physical symptoms if they believe (or want to believe) that they've been given the drug even if they haven't, kind of like somatoform. Also related is the idea of cognitive dissonance, where the patient gets better because they have to rationalize spending their time and money at therapy/getting and taking the pills. The FDA requirements from clinical trials in approving drugs was frightening. All year we learn about how studies must be repeated over and over again, and yet only two clinical trials with "statistical significance" are needed in order for a drug to pass. This seemed wholly corrupt and neglectful. Not gathering enough data to make an educated assessment not only endangers patients in terms of possible side effects, but it's also taking advantage of people who really need help by allowing profit to be made selling possibly ineffective drugs. The article said that those with severe depression would perhaps benefit more from a combination of psychotherapy and an initial prescription of antidepressants. I found this incredibly interesting, because it led me to believe that this information combined with the idea of the placebo effect could potentially make antidepressants unnecessary as a whole. If the placebo effect and therapy is behind real improvement for those plagued by severe depression, the entire pharmacy industry would suffer a huge hit. This gives some insight behind the possible reason why the FDA is so lax with requirements, and the backlash that was met by the studies. I think from the evidence provided, it's likely that the "cure" to depression is a combination of therapy and inexpensive placebo drugs. I'm not aware of how much a small pill of basically nothing costs to make, however if placebos really can produce the same results as the real thing, there is absolutely no reason why any patient should ever have to pay a significant amount for them. I think that we can't rule out any pill altogether because it's part of tricking the human mind into thinking it's doing something to get better. We learn that actions produce results. This concept only works if we continue to use placebos in conjunction with the therapy that helps us work through the psychological issues.
ReplyDeleteI'm really excited about the post because I have a lot to relate it to. For starts, last year I wrote a research paper on the reverse effects of anti-depressants in adolescents. After gathering all of that information I was positive that anti depressants do much worse than good for people at all ages. There are so many untold stories of people that have reverse reactions to these types of drugs (SSRIs) that people have to wonder who they're really helping? Could it just be the people that the placebo pill would work on too? I would be really interested to explore the studies of double blind procedures for anti depressants. Just recently I was given a similar drug called Lorazepam for anxiety which is used to slow down activity in the brain... sounds pretty dangerous to me. And it was for anyone that's seen my eye ball lately. I got every single side effect listed for this drug and I only took half the amount I was allowed. Scary stuff. But back to anti depressants, I work for a research and development company called Lundbeck that makes drugs for depression, bipolar, and schizophrenia disorders. We just recently got on the list for FDA approval for a new drug and it was a huge deal. My boss was explaining to me how long and detailed the process of getting a drug approved is and I think it's done pretty well. First starting off with animals, than a small group of humans, than a larger and larger, etc. There are many precautions to this process but that makes me wonder how some drugs were able to get out there... like the crazy pills I got. It's hard because everyone has a different reaction to everything so how can one common drug be suitable for a large group of people? The world may never know...
ReplyDeleteI was really intrigued by the anecdote that the author presents at the beginning of this article...when she knew of the overwhelming placebo effect in regards to drugs, she chose not to inform her friend of this pitfall. Judging by the reactions of everyone else, it's safe to say that the possible ineffectiveness of these drugs is relatively unknown to the public. I think that the approach that the author takes in her story is the same approach that most who do know of the placebo effect also take. Certainly, we've made immeasurable scientific advances in our era, but I don't think that the public realizes the extent to which we still don't have the answers -- and it is perpetuated by those who do have this knowledge choosing not to share it. Maybe it's for business-enterprising reasons, that we want to sell drugs regardless of how well they work. Maybe the perception is that with our current scientific shortcomings, the placebo effect is our only other hope for treatment with drugs that don't completely alleviate disorders. By any means, our drugs have yet to improve.
ReplyDeleteI thought this article was really interesting because the placebo effect is something that is not normally talked about when treatment options come up. In general, for any type of treatment, an individual must be willing to participate fully in all aspects of the "healing". When a patient believes in the approach he or she is taking, such as taking an antidepressant or a placebo pill, he or she is more likely to improve in capability and symptoms.
ReplyDeleteI think our society also emphasizes certain roles, such as patient and doctor. As a patient, a person is expected to trust his or her doctor and the methods they choose to follow; as the doctor is expected to "know all" and always do the best for his or her patient. Each role has assigned actions; the doctor prescribes and the patient heals.I think a lot of times those who seek help in therapy or through some medical means are so ingrained with these social roles that they actually begin believing treatment is working, whether it actually is or not.
When a person completely buys into the therapy his or her doctor decides on that person is more likely to go along with the expected recovery of the medication. This plays into the placebo effect because when a person is given a certain medication he or she has trusted that his or her physician prescribed not only the correct medication, but in the right dosage as well.
The placebo effect is when a patient is given a fake pill for a treatment with the belief that it is the true pill, so the power of their mind overrides their disorder. this could greatly affect a person with depression because the root of the psychological problem could be their outlook on life. I think the FDA requirements are extremely necessary. In an age where people abuse pills (we did our project on RX drugs) we need an agency overseeing the distribution of drugs.
ReplyDeleteI think regardless of mild, moderate, or severe, everyone is different and will respond differently. Our chemical balances are different so our drug prescriptions and doses have to be also.
i think antidepressants have to be used alongside therapy. I firmly believe depression is not just a biological disorder. Something is wrong with the person's life which is affecting how they perceive the world. We can't just give them a pill and show them the door. Support and sympathy is essential