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 Re: Drugs for depression don't work (Re: Mohamed Omer)
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Prozac and the placebo effect
The Guardian, Friday February 29 2008
As a GP and therapist with over 30 years' experience, I feel the media have, in the main, missed the point of Professor Irving Kirsch's recent work (Prozac, used by 40m people, does not work say scientists, February 26) - that it is not that antidepressants may not work but that, in many cases, placebo works just as well
Why has placebo such a bad press? Far from being something we should try to avoid or play down, the placebo effect should be celebrated. It is of supreme importance in medicine. Thirty years ago GPs could prescribe an innocuous vitamin pill with plentiful suggestion to generate expectation of healing and on many occasions it would work. But it was not "scientific" enough and with increasingly slavish adherence to "informed consent", and side-effect leaflets in all prescribed medications, it became no longer possible to use this
Expectation has been shown to be a key factor in the success of any counselling or psychotherapeutic approach; why not in every aspect of medicine? The placebo effect, mediated by intention, expectation and suggestion, enables and potentiates the person's natural healing capabilities - and is arguably the mechanism by which many "complementary" approaches work
What a wonderful thing, the placebo effect - no side effects and works successfully at least a third of the time. Let's use it, not knock it!
Ann Williamson
Ashton-under-Lyne, Lancashire
In the debate on antidepressant medication one important point has been overlooked: "depression" may not actually exist as a valid, discrete clinical concept. Those who are collectively termed as suffering from "clinical depression" are a remarkably diverse range of individuals. Some have problems with drugs or alcohol. Others can trace their depression to experiences of loss or abuse. Still others seem to display a biological vulnerability to low mood for no clear personal reason. Lumping them all under a single heading of "depression" may be convenient for the healthcare and pharmaceutical professions, but we should not be surprised if we find that a simple pill - made of sugar or anything else - fails to make a real difference to something as complex as a troubled mind. We know antidepressants have a very clear effect upon fear, motivation, sleep, appetite and so on. Rather than asking what these drugs do to "depression" we might be better off asking just what they do to many processes in the brain for which we have much more reliable names
Dr Mark Salter
Consultant psychiatrist, City and Hackney Centre for Mental Health, London
"Depression" is used to describe the feeling of distress in response to adverse life events as well as a brain disorder - two completely different entities. Human distress is not relieved by medication, but equally psychological therapy won't help someone with a brain disorder. The medicalisation of distress by social psychiatrists has served the interests of drug companies who don't care who antidepressants are prescribed to, so long as they are prescribed plentifully
Richard Hackett
Consultant psychiatrist, Manchester
It is ironic that as the evidence base for antidepressants is seriously questioned, the "army of therapists" who will "push the pills aside" (Report, February 27) will largely be offering cognitive behavioural therapy. It is claimed CBT has a stronger evidence base than other psychological therapies. In fact this evidence has, like the antidepressant evidence, been "massaged". Only in the small print of the National Institute for Health and Clinical Excellence guidelines that are pushing CBT as "the" psychological therapy do we find statements like "the clinical evidence review showed no overall superiority for CBT alone on treatment outcomes over antidepressants". Out of the frying pan
Malcolm Learmonth
British Association of Art Therapists
Why do comments such as "These drugs worked for me" and "The SSRIs definitely help" make headlines (February 27), while similar anecdotal comments on the efficacy of, say, homeopathic remedies, are condemned as "bad science" and followed by comments on the power of placebo effects?
David Wheeler
Manchester
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Mohamed Omer
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