You may think this is a strange question but many people have commented to me that they don’t seem to think their antidepressants are working.
Hence the question: Are antidepressants placebos?
It brings into focus the whole idea about taking antidepressants for depression, their appropriate usage and effectiveness.
There could be three reasons why we would think our doctor gives us something that we think are ‘fake depression pills’:
Maybe they don’t work for some people
Maybe they’re given to simply placate the patient
Maybe there is actually a placebo effect when given antidepressants
It can seem extremely confusing if we go to the doctor for treatment for depression, get a prescription and feel no better; or even worse in some cases.
We are fed the story that antidepressants are so effective that it can seem as if they’re a magic pill. But, the evidence is in the results, which don’t always relay the same story.
Are Depression Pills Placebos?
Antidepressants are definitely not placebos and let’s look at the difference between the two.
Antidepressants
Antidepressants are pharmaceutical drugs which have a powerful effect on the body.
To illustrate that, here’s an in depth look at Prozac, the most commonly prescribed antidepressant.
Prozac
Prozac is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. The main ingredient of Prozac is a chemical called fluoxetine.
Fluoxetine is commonly prescribed for the treatment of depression, bulimia, panic disorders, obsessive-compulsive disorder and premenstrual problems.
Fluoxetine apparently works by making more serotonin available in the brain.
Although, the efficacy is controversial, it is generally accepted that while fluoxetine is good for severe depression, it’s not so effective for mild to moderate depression[i].
What Are The Side Effects Of Fluoxetine?
Some of the problems with Fluoxetine are the side effects. Here’s a list of common side effects:
Abnormal dreams
Abnormal ejaculation
Agitation
Anorexia
Anxiety
Asthenia
Diarrhea
Dry mouth
Dyspepsia
Erectile dysfunction
Flu syndrome
Hives
Impotence
Insomnia
Itchiness
Decreased libido
Nausea
Nervousness
Pharyngitis
Rash
Sinusitis
Somnolence
Suicide risk
Sweating
Tremor
Vasodilatation
Yawning
What Is Discontinuation Syndrome?
This is an adverse effect of fluoxetine that may happen when you try to come off the drug. It’s important to discontinue the drug slowly. Rapid discontinuation may cause:
Feeling unbalanced/wobbly
Dizziness
Nausea
Headaches
Vomiting
Disturbed dreams
Insomnia
Numbness
Tingling
Hallucinations
Irritability
Because this drug, fluoxetine, has been identified as possibly not effective for mild to moderate depression, if that’s the type of depression you suffer from, you may not feel the relief you expect.
Placebos
Placebos are pills that have no pharmacological effect and are used to experimentally test the efficacy of drugs by being administered to a controlled group of human guinea pigs.
They are also administered to satisfy patients who presume it is a medicine.
The main ingredient of a placebo pill is sugar
What Are The Side Effects Of Placebos?
There are NO side effects and there are no discontinuation symptoms.
Are Depression Pills Dispensed To Placate The Patient?
A controversial question? Indeed it is but I have been asked: is the doctor just giving me anti-depressants to pacify to me?
The debate about whether or not antidepressants are effective AT ALL appears to be gaining momentum.
One of the reasons is because of the ongoing problems with clear efficacy results of clinical antidepressant trials and the subsequent disclosure from the drug companies. It seems that the results from these trials are regularly withheld from doctors as drug companies seem to publish only 50% of their results.
This is called ‘selective publication’ and this has only been discovered unintentionally as external researchers have compared results of published trials with information from surveys taken on the same trials and have found the figures don’t add up.
This appears to be a perfectly legal practice. However, it allows the drug companies to misinform our doctors on the actual results of antidepressant trials.
Where’s The Integrity?
There is also the question of integrity as it’s been reported that many studies on antidepressants have been funded by pharmaceutical companies who manufacture the drug.
This illustrates a hidden conflict of interest between the corporate drug makers and clinical trials of the drugs themselves.
So what does this tell us about the efficacy of antidepressants on our depression?
There are opposing opinions within the medical factions on antidepressants and they sit at polar ends of the spectrum. On the one hand,[ii] placebos improve depression nearly as much as the active drug and there’s little significant difference between the two.
On the other hand[iii] these drugs work as well as any other drugs prescribed by a doctor.
When we arrive at the doctor’s for help, we have to be mindful that doctors may well be trying to placate us with what they believe is a quick solution.
Can We Blame Our Doctor?
It might be prudent to look at the process of how the doctor takes a decision to prescribe antidepressants in the first place.
The training regime for doctors dictates how they respond to a patient who displays depression symptoms. They are instructed to assess the symptoms of the patient and they then have several options on treatment.
The first option is usually antidepressants. Antidepressants are a quick and relatively inexpensive way to ‘treat’ depression. This is backed by the claims made by the drug companies through their direct-to-consumer advertising.
Strap lines like:
It's time to feel better about facing the world
Put your brave face on
A third of people got their life back
With claims like these it’s clear that both the patient and the doctor would believe that antidepressants were the answer.
However, one study[iv] emphatically concludes that drug companies contribute to the confusion about antidepressants by:
Downplaying the health risks
Hiding behind the smokescreen of public relations slogans like medical awareness campaigns
Over medicalizing everyday experiences like grief, sadness, anxiety and shyness
Doctors want effective treatment options while we, the patients, want to access transparent and clear information about how antidepressants will work for us.
It’s up to the drug companies to provide a better understanding on both.
Is There Actually A Placebo Effect In Simply Being Given An Antidepressant? Yes, There Maybe Well A Placating Effect In Being Given Depression Drugs.
We arrive at the doctor’s door with a need to be taken care of. Once we’ve told him/her how we feel, we hope for empathy and guidance on how to get better.
We listen to what the doctor says and trust they know what they’re talking about. We may not hear the ‘warnings’ about side effects. Or maybe we do but we don’t’ care at that point. We’ve placed our recovery in the their hands.
We’ve probably Googled depression treatment beforehand and discovered that the prolific option is antidepressants. All the biggest players on page one advocate their use.
So, when we hear that antidepressants are the best option for depression, we take the pills and go home, trusting and hopeful that we’ll feel better.
Does this have a placebo effect on us? Of course it does. We’ve trusted our doctor’s judgement; why wouldn’t we?
It could be that, because we believe the depression pills are going to work, we take them. And, when we feel different, we think this is good.
The two things to bear in mind are:
Firstly, when you’re so depressed you can barely lift your head up, any difference in mood may be considered positive. However, it’s possible to get a difference in mood with other psychoactive mood-alterer like caffeine, alcohol, over-the-counter painkillers or street drugs.
Secondly, on the efficacy of the antidepressants themselves, we need to better understand why they are more beneficial to some people and not to others. But, to do this, we need all trial results published, not just the ones selected by big pharma.
Reference:
[i] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2253608/
[ii] https://www.ncbi.nlm.nih.gov/pubmed/25213159
[iii] http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html
[iv] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313530/
You understand that you should always consult your physician or other healthcare provider to determine the appropriateness of this information for your own situation or should you have any questions regarding a medical condition or treatment plan.
This information has not been evaluated or approved by the FDA and is not necessarily based on scientific evidence from any source. These statements have not been evaluated by the Food and Drug Administration (FDA).
The products referred to in the books or programs are intended to support general well-being and are not intended to treat, diagnose, mitigate, prevent, or cure any condition or disease.