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:
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?