February 22, 2012

DEPRESSION: The Placebo Problem

On February 19, the CBS news magazine 60 Minutes aired a segment (“Treating Depression: Is there a placebo effect?”) on which psychologist Irving Kirsch claimed that placebos help most people with depression as much as antidepressant medication.

Needless to say, for the 17 million Americans who take antidepressants – and for the pharmaceutical companies that take in about $11.3 billion every year selling those pills -- the assertion is a bombshell.

Kirsch, associate director of the Placebo Studies Program at Harvard Medical School, explained the common wisdom about placebos: since the expectation of healing is so powerful, people actually DO feel better after taking the “dummy pills.” He also said: “Placebos are great for treating a number of disorders: irritable bowel syndrome, repetitive strain injuries, ulcers, Parkinson's disease.”

Brown University Medical School professor Dr. Walter Brown has conducted several studies which support Kirsch’s findings. He claims that antidepressant use in the last ten years has increased most among people who are mildly depressed… just the group – Brown says – most likely to benefit least from the drugs.

He also questioned the process by which the Food and Drug Administration approves drugs: a built-in part of the problem. To approve any new product, the FDA requires only that companies show that their pill is more effective than a placebo in two clinical trials. It doesn’t matter if an assortment of other trials of the same product fail to show any positive results. Two successful trials and… approval. Given that reality, Kirsch’s placebo claim seems less dramatic.

Yesterday -- the morning after CBS aired the report -- a friend who has been using anti-depressants for 20 years called to talk about it. She mentioned to me that she has tried several times to slowly wean herself off her medication, but after several weeks without the pills, she started to “feel the shadows creeping back in around the edges.” She thought perhaps that the return of her symptoms proved the efficacy of the medication.

I wondered aloud: if she’d been taking a placebo (with results) and then stopped taking those pills, might not the same thing have happened? After a moment, she said, “Oh my god.”

As Kirsch argues, it’s the act of taking the pill – and believing in it – that matters… and NOT what the pill contains.

Here’s a link to the15-minute segment; I have a sneaking suspicion we haven’t heard the end of it: Placebos for Depression?

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