Anti-Depressants and the Placebo Effect

Considering all of the abject nonsense that is taking place on college campuses these days, it comes as a pleasant surprise to read a student newspaper report on an interesting and intelligent story about anti-depressant medication.

The story, from the University of Connecticut newspaper, The Daily Campus, quotes Blair Johnson, professor of social psychology at the university who lectured on the placebo effect produced by anti-depressants.

With the exception of those who are severely depressed, Johnson says, placebos work as well as anti-depressants. This means that SSRIs are grossly overprescribed in America.

Kimberly Armstrong reports:

Blair Johnson, a professor of social psychology at the University of Connecticut, said his research has shown placebos to have the same effect as anti-depressants for all but the most severely depressed patients.

Johnson, who was recently recognized as a Board of Trustees distinguished professor, spoke Tuesday evening in Oak Hall at “Pills, Placebos, Exercise and Interventions: How Best to Improve Mental Health.” He said that while drug trials have shown anti-depressants to improve patients outcomes, the difference between a pill and a placebo was only discernible when his team used statistics to “torture the data.”

“Antidepressants are little better than placebos except for in severely clinically depressed samples,” Johnson said. “The implication was that medical doctors are overprescribing antidepressants because most patients are not severely depressed.”

It’s about the power of belief, Johnson said. If you believe that it is going to make you get better, you are more likely to feel like you are getting better. You would not want to disappoint the person who is prescribing the pills. One imagines that it is far easier to sustain the placebo effect when dealing with mental illness. I have argued in my book The Last Psychoanalyst that when psychoanalytic treatment produced rare benefits it could easily be ascribed to the placebo effect. 

One applauds Johnson for telling students the truth about anti-depressants. And for explaining that, aerobic exercise is a far better treatment for depression. Besides, SSRIs produce many unpleasant side-effects.

Armstrong writes:

For most patients, “the power of belief” is enough. In a study of cancer survivors, who have an elevated risk of anxiety and depression, Johnson found that aerobic exercise improved their self-reported quality of life across the board.

“The side effects of exercise are a pure delight, so why not go there?” said Johnson.

In fact, the benefits of exercise run almost entirely counter the side effects of antidepressants, which can result in sexual dysfunction, headaches, insomnia, nausea, seizures and increased risk of suicide, just to name a few.

Johnson also suggests, as I have, that depression and anxiety are often produced by social dislocations, rather than chemical imbalances. If we want to reduce depression we need to find ways to help people to overcome anomie, not to drug them into a stupor. In an increasingly fragmented and multicultural socius people are confused about where they belong, whether they belong, what they need to do to belong. The result is anomie, which translates into despair and anguish.

Another U. Conn. professor suggests that anti-depressants often worsen the symptoms they are supposed to treat:

Professor of behavioral neuroscience John Salamone said this means that antidepressants, particularly SSRIs or selective serotonin reuptake inhibitors, often contribute to the very symptoms they are intended to treat.

“When people look not at broad measures of depression but at specific systems it turns out that SSRIs don’t work well at all,” Salamone said. “There’s an irony there that a lot of people are getting medication which can actually make the symptoms worse.”

In order to produce a placebo effect, the culture must create a climate of belief in which everyone believes that the medication is believed to be effective. Thus, reacting positively to it makes you a member in good standing of the community. Not responding makes you an outcast.

Johnson remarked on a study which showed that when people with chronic knee pain were given faux surgery—i.e. they were put under an anesthetic, received an incision on their knees and were told that they had received surgery—they felt the same level of pain reduction as did those who had really undergone surgery.

More interesting is Johnson’s argument, to the effect that the media, with its constant proselytizing for anti-depressants has produced the kind of conditions that facilitate the effects of the placebo:

Johnson recognized, however, that the media often shapes society’s perspective on these issues. He said campaigns extolling the benefits of pharmaceuticals may be at the root of the placebo effect’s increasing influence.

“They’re really trying hard to maintain this faith in antidepressants,” Johnson said, whose studies have faced vocal opposition from the pharmaceutical community.

Of course, it is also true, as Ethan Watters argued in his book Crazy Like Us, that media campaigns can produce epidemics of specific kinds of mental illness, from the hysteria that invaded Europe in the Victorian era and that disappeared in the 1920s to the anorexia that overtook Hong Kong in the late 1990s.