Are antidepressants really just placebos? This is the provocative question posed by some recent research and journalism. The answer is not what you’d think for a medication with $14 billion in annual U.S. sales taken by 17 million Americans.
On January 29th there appeared a well researched and well written piece in Newsweek on the effectiveness of antidepressants. The article, by Sharon Begley, explains some important aspects of the process by which pharmaceutical agents are brought to market and are prescribed.
The Placebo Effect
The article explains about the relevance of the placebo effect in clinical trials. It goes on to explain that much of the improvement antidepressants produce can actually be attributed to the placebo effect. The placebo effect is the extent to which our experiences and expectations that a drug will work actually help us improve.
For example let’s say that you get frequent headaches, and find that aspirin gets rid of them pretty effectively. Then one day your prankster roommate replaces your aspirin with breath mints” but your headache still goes away after you take one! Some would explain this via the placebo effect — you expected it to work, and so it did. The placebo effect is a mysterious and important part of medical research; so much so that it is a focus of significant ongoing research at medical institutions around the world.
Scientists have known about the placebo effect for many decades and account for it in research often by using what are called placebo-controlled studies — i.e., studies where half the patients receive the drug under investigation, and the other half receive a placebo. Thus they can look at the difference in improvement between the two groups and conclude that any difference is likely due to the true effect of the drug.
How Does the FDA Actually Know That Antidepressants Are More Effective Than Placebos?
Begley’s article may shock you in its description of how strong the placebo effect is for antidepressants. It also provides a surprising description of how such medications are approved by the FDA. She describes how the FDA, at present, does not have a mechanism by which trials with negative results (showing that a drug was ineffective) are accounted for in its pharmaceutical approval process. That means that a drug shown to be no better than placebo in six studies, but shown to be somewhat effective in two others, can be approved and marketed for widespread use.
Learn more in this 60 Minutes piece on antidepressants and the placebo effect:
Read the Newsweek article, and be an informed consumer!
Subscribe to the Manhattan Center for Cognitive-Behavioral Therapy blog!