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The Placebo Effect: Should we be giving sugar pills to our depressed patients?

OPINION

There is currently a big debate in psychiatry: Do anti-depressant drugs really work? The fact is that in clinical trials to discover new drugs, the placebo (sugar pill) group of depressed patients gets about one-third better, while the patients that actually get a successful new drug show little more than a 50 percent improvement.

The 20 percent average improvement of drug treatment over ‘sugar pills’ seems relatively insignificant, and may be accounted for by the design of the experiment and statistical analysis all conducted by pharmaceutical companies that spend perhaps $20 million to get the FDA to approve their new drug which they hope to sell billions of dollars.

This debate raises many interesting questions. Does the placebo group get better because time is the great healer and depressions often improve on their own in a few months? Does the placebo group’s weekly assessments of their depression really amount to some form of empathic ‘therapy’? Do the often-common side effects suffered by the active treatment group let them know that they are actually getting the real drug and therefore predispose them to higher rates of recovery by actually increasing the ‘placebo’ effect?

The debate becomes even more complex as patients with ‘severe’ depression show comparatively greater response to drug treatment over placebo. Further, anti-depressants may be clearly preferable to placebo in many well-researched specific conditions like recurrent postpartum depression or depression accompanied by severe anxiety or OCD.

Big pharmaceutical companies, with big financial interests at stake, are in charge of drug studies, while the FDA only acts to review their results. This is a patently biased and unscientific model. An impartial scientific entity conducting these experiments would clearly result in better science, better new drugs and less suffering for patients.

In my view all healing takes place as both doctor and patient try to maximize the synergy of their collective personal, social, psychological, cultural, religious or spiritual beliefs in their treatment. Therefore, we should do everything possible to strengthen, rather than to eliminate or control, the ‘placebo effect’.

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