Note: this article contains information regarding antidepressant medication. Consult your GP before making any changes to your medication.
Over the past few years, research has shown placebos can have a positive effect in the treatment of depression.
One study showed in some instances, there is little difference between the effects of placebos and active medication when given to people with mild to moderate depression and accompanied by supportive care.
In another, 30 to 50 per cent of responses to antidepressants could be attributed to the placebo effect.
Rather than delivering the death knell for a wide range of antidepressants, the research could spell a greater age of understanding about who responds to such medication - and who doesn’t - and how placebos can be used to assist people suffering from mental illness.
“I’m pleased we have research that shows where antidepressants are effective and not effective,” says Associate Professor Michael Baigent, a psychiatrist and Beyond Blue board member. “We don’t have all the answers. We need more research in this area.”
"I’m pleased we have research that shows where antidepressants are effective and not effective."
This week, Insight is looking into the remarkable, and sometimes inexplicable, impact of placebo.
Dr Charlotte Hespe, speaking to Insight’s Jenny Brockie, says this impact, in the case of depression, can start before medication is even taken.
“There’s no doubt that giving somebody a script with a piece of paper and things to do is incredibly therapeutic,” says Hespe.
“Sometimes the patient’s recovery really is helped when they feel they are being listened to by a medical professional.
“With many of these patients a trouble shared is a trouble halved.”
Associate Professor Jeffrey Looi, the psychiatry representative of the AMA, agrees that this can be a powerful tool.
“The symbolic significance of prescribing medication has been known for some time,” he says.
“There is significance in validating and acknowledging someone’s distress."
Dr Cristina Beer, a guest on the show alongside Hespe, also notes the placebo effect can be a bridging mechanism between when a patient first starts on medication and the time when it kicks in.
She says she often sees patients come back within the first one to two weeks for a check-up saying they already feel better.
“But we know the medication doesn't kick in until four or six weeks after you've prescribed it,” she says.
“It’s an interesting phenomena … often the clinical depression is lifted, they're feeling like they can enjoy life again, they've given themselves maybe permission to just start … perhaps there is some biological, biochemical process in that and in any case. I think it's a positive effect.”
In both examples, expectancy is key – something researchers say is an important factor in any placebo’s efficacy.
The more someone anticipates an outcome, the more likely they are to experience it in the prescribing and eventual taking of the medication.
“I find it really interesting about how you use the expectation to your advantage,” says Hespe.
“I don't see that as deception, I more see it as being part of the role of where you're using the therapy that you've got at hand.”
To an extent, Looi agrees.
“Whether these are direct effects of medication or placebos effects, it doesn’t really matter if patients are getting better.”
“The difficulty [though], is if the patient isn’t getting better. Troubleshooting then gets more complicated.”
While the research indicates placebos work at the mild to moderate range of depression, there is no proof of their effectiveness for people with severe depression.
Conversely, the evidence shows quite conclusively that antidepressants have a tangible effect for people suffering severe depression.
Ultimately, the great variety in responses to medication means treatment should be tailored to the individual.
"Whether these are direct effects of medication or placebos effects, it doesn’t really matter."
“It is a really puzzling area,” says Baigent. “I have seen people who don’t respond to antidepressants when I’ve expected them to, and people who have responded to them when I haven’t expected them to work. I’ve seen them save lives. It is a very complex area.”
He notes the research about placebos means doctors should have a greater range of treatment options available to patients, to replace or accompany antidepressants, with things like increased exercise and psychological support shown to have great effect.
Is it ethical for doctors to be prescribing antidepressants to patients with milder forms of depression, when research has shown that in some cases they have little effect?
“I think principally we've got to remember that human experiences are in shades of grey,” says Beer. “I think the placebo forms part of this grey zone and if we can harness it, realising that human psychology and physiology fits in the grey zone, there's probably no overt wrong or right when you're dealing with placebo.”
Both Looi and Baigent also found it hard to say whether it was ethical or unethical practice, acknowledging the pressure on GPs spread thinly across multiple patients and different illnesses, and the difficulty turning down a specific request for medication.
In the end, the decision about treatment is two-way, placebo or no placebo.
“It has to be a discussion,” says Looi. “GPs have to work in collaboration with patients.”
Insight, ‘Placebo’ | Tuesday 8:30pm, SBS