Tuesday, October 16, 2007

Treating Depression with Placebo Therapy

(cc) HISHAM BINSUWAIFIf you are the type of person that finds anti-depressants or other psychotropics lose their potency over time, maybe they were never effective in the first place.

The closest most people come to placebos is their television set. You've seen the plot where the rotating character of the week has a child/spouse/pet with a tragic and untreatable malady in desperate need of an experimental drug. The trouble is nobody knows whether the loving test subject is receiving the wonderful new miracle pill or the sugar pill. Lots of things happen that have nothing to do with the test subject, usually involving a homicidal nurse jealous of being passed up for a promotion from the morgue who exacts her revenge by mysteriously killing vending machine servicemen who are secretly part of a cabal of old high school chums. Somehow our intrepid main characters foil her nefarious plans and in the last five minutes we learn that the test subject, who has shown astounding improvements, has been on the placebo the whole time. You haven't seen it? It's a classic.

The message of the show is either that one shouldn't kill high school alumni who are happy with their lot in life filling vending machines*, or that any improvements the test subject experienced were due to the love and nurturing of the rotating character of the week - the recovery was due to their mind believing they were being cured. This latter message is often trite, overused, and hackneyed but it turns out that it might also be very true.

According to a report released in August of this year in the Journal of Clinical Psychology, two doctors (Mark Zimmerman, M.D., and Tavi Thongy, M.D.) decided to document the phenomena where some patients stopped responding to their medications. More specifically, they wanted to estimate the proportion of people who truly stopped responding to their medication versus those who experienced the same relapses but where on placebos. You can read a summary of their findings at Psychiatrist.com, but the salient bits are that a "substantial number of patients who respond to antidepressants experience a relapse despite ongoing pharmacotherapy" and that a portion of that large number of patients were actually on placebos. If you want to understand why a substantial number of patients experience a relapse, head on over to this cheeky but fact-filled post over at the Last Psychologist. All is not what it seems in Pharmacology Land.

I realize this is a lot of data to crunch, but the important part is that the people on placebos initially experienced improvement. Read that part again. In addition, of those tested about 75% never relapsed at all. They believed the drugs were real and they saw improvements in their life. Lasting improvement with the help of sugar pills. Do you realize what this means? You can replace your $70 bottle of psychotropic-du-jour with Skittles? Sounds tasty, but no. Dr. Zimmerman said it best in an interview with Reuters when he suggested "that a message can be conveyed to patients who have repeatedly improved on medication and then lost its benefit that perhaps they are more capable than they think in bringing their own resources to bear to improve their depression."

For those of you who find yourself, like I found myself years ago, doing the medication tango every few months trying to find a dosage or med that worked perhaps your true solution is within. Everything you need to see improvement in your life locked up in that knobbly mass of grey matter. IF you only believed. The problem is that most of us have been duped. As the Last Psychiatrist (an academic psychiatrist specializing in forensics, btw) put it:

What's amazing to me is how skeptical everyone is about Pharma, how they distrust anything they say, and whine that the drugs are too expensive, but they've all bought Pharma's biggest scam: that these drugs are necessary.

OK, so Big Pharma misleads the public about their product's efficacy so they can sell more. This is big business at work, just like in any other industry. What does that mean for you if you find yourself in need of help and not responding to meds? My first bit of advice is to tell you to not knock the power of positive thinking. I know I sound like a skipping CD over here but I cannot emphasize enough what a change I made in my own life by the simple act of forcing myself to be more optimistic and positive about the day. I also had the will to conquer my anxiety, which I did, and my depression, which I still work on but have seen phenomenal improvements in my life. Mostly, I believe that I can be in control and I take steps to help me realize that belief.

Those placebo relapsers failed because faith alone couldn't help them. They needed to change their thinking habits to stay on the path towards mastery. That is why it is important to not rely solely on positive thinking. I can't recommend enough the services of a good cognitive behavior therapist. Positive thinking took me only so far, but the helpful advice of my CBT helped me take myself to the next level. They can help you learn the coping strategies you need to succeed. In the end, though, it is all up to you. Dr. Zimmerman was right. You are more capable than you think.

*Disclaimer: I used to service my own fleet of stellar vending machines so I can make fun of vending machine servicemen. It was in my contract.

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