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Sugar pills cure
depression just as well as antidepressants. What’s more
is that sometimes they work better.
According to a
new analysis, the majority of antidepressant trials conducted
by drug companies have found that sugar pills, or placebos,
produce results similar to or better than antidepressant drugs.
In one study of 96 antidepressant trials conducted between
1979 and 1996, no difference could be determined between the
effects of antidepressants and sugar pills in some 52 percent
of trials.
Drug companies
are required to conduct two trials that yield positive results
before the product will be approved by the Food and Drug Administration
(FDA), and reportedly numerous trials had to be conducted
before positive results could be shown. The makers of Prozac
ran five trials before obtaining two that were positive, while
the makers of Paxil and Zoloft had to conduct even more, according
to researchers.
In one recent trial,
which compared the effectiveness of the herb St. John’s
wort to that of antidepressant drug Zoloft, St. John’s
wort alleviated depression in 24 percent of study participants
compared with 25 percent for Zoloft. However, the placebo
cured depression in 32 percent of participants.
The findings do
not mean that antidepressants such as Prozac, Paxil and Zoloft
do not work, however researchers say that Americans may be
overestimating the drugs’ effectiveness. Much of the
improvement shown during clinical trials may be due to the
close attention and evaluation the patients receive during
the study -- a phenomenon that does not occur for most patients
who use the drugs in everyday life.
Moreover, the sugar
pills actually cause changes to occur in the same areas of
the brain affected by the antidepressant drugs, according
to recent research. It was also found that more patients’
depression is being alleviated due to placebos now than 20
years ago.
Placebos, or pills
that have no effect, have long been used by scientists to
distinguish the real effects of medicine from the illusive
feelings of patients. Often in the field of medicine patients
experience what is known as the placebo effect -- the feeling
of getting better after being treated with placebos.
However, it seems
that placebos may actually make a difference in the treatment
of depression, as the disease is characterized by how people
feel.
Many psychiatrists
say that drugs alone will not cure depression. Instead, a
combination of medication and psychotherapy appears to yield
the best results. Despite this, antidepressants have become
the automatic treatment for most cases of depression.
In 2002, there
were close to 25 million doctor visits for depression, up
from 14 million in 1987. Of these visits, medications were
prescribed for nine out of 10 patients, according to recent
research.
It is not known
how many of these patients received therapy in addition to
the medication, however, in 2001 less than one-third of doctor
visits for depression were to psychiatrists and two-thirds
of them were to primary care physicians. According to researchers,
psychiatrists are more likely to administer medicines along
with therapy, while physicians, who are less knowledgeable
about therapy, are less likely to offer therapy to their patients.
Other studies have
shown that in an average eight-week trial, each study participant,
whether taking drugs or placebos, is questioned and examined
by experts and caregivers for about 20 hours. Comparatively,
the average depressed patient likely sees a doctor for only
20 minutes a month.
To add a piece
to the puzzle, researchers say that often patients with similar
symptoms have different problems with their brain chemistry.
The neural mechanisms behind this, and the reasons why antidepressant
medications work, are not fully understood.
In one study that
followed changes in the brain associated with antidepressant
drugs, results showed that many of same changes occurred in
patients who took placebos. The parts of the brain that were
primarily affected are thought to play a role in mood.
In this particular
study, 38 percent of depressed patients got better from taking
the placebo, compared with 52 percent from the medicines.
However, once the
trial ended and the patients were told what they had been
taking, the patients who had been on placebos fell back into
their depression. It appears that one’s belief in the
effect of antidepressant may account for the improved feeling
in patients.
While some say
that antidepressants drugs work primarily because of the placebo
effect, others believe that the drugs produce an effect of
their own. A related study found, through the use of a brain
imaging technique, that these medications do in fact produce
changes in the brain stem that did not occur in patients taking
placebos. However, the effects of these changes are not yet
understood.
The analysis led
many to say that an integrated treatment that takes into account
both biological and mental aspects may prove beneficial in
the treatment of depression.
International
Journal Neuropsychopharmacology September 2002;5(3):193-7
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