The following column appeared in the Sunday NY Times Web edition:
Placebo Nation
By JOHN HORGAN
Over the past decade, psychiatrists and the news media
have proclaimed
the wonders of Prozac and the rest of a new generation of
antidepressant drugs, known collectively as selective
serotonin
reuptake inhibitors. Now a report from the United States
Department of Health
and Human Services has confirmed what has long been an open
secret among
mental-illness researchers: the S.S.R.I.'s are no more
effective at treating
depression than older classes of drugs, like tricyclics.
Buried within this report is a larger and more disturbing
story.
During the past century, while scientists have acquired ever
more detailed
information about the brain with ever more powerful
technologies, there have
been virtually no genuine advances in treatments for
depression and other
common mental disorders. From psychoanalysis to Prozac, all
the therapies
offered so far are roughly equivalent in their effectiveness,
or lack thereof.
Roughly two-thirds of patients receiving any form of treatment
for depression
show some improvement. On the other hand, as many as half of
those who
don't receive treatment improve anyhow.
The most common therapy in the first half of this century was
the talking
cure, popularized by Freud. There are now hundreds of talking
cures, from
Jungian dreamwork to cognitive behavioral therapy. Although
each is touted
as an improvement over its predecessors, scientific tests have
found that all
psychotherapies are basically equal.
The advent of drugs like tricyclics in the 1950's was
initially seen as an
enormous advance beyond psychotherapy in treating depression.
In fact,
various studies say that antidepressants and psychotherapy
produce more or
less the same outcomes.
The new report, summarizing many studies, concludes that about
50 percent
of severely depressed patients taking the drugs improve,
versus 32 percent of
those taking a placebo. Even this apparent advantage may be
illusory,
according to researchers like Roger Greenberg, a psychologist
at the State
University of New York Health Science Center at Syracuse.
Clinical trials are supposedly double blind: neither the test
subjects nor the
researchers are told who is receiving the drug and who is
receiving a placebo.
But because all psychiatric drugs have side effects -- like
dry mouth,
constipation and sexual dysfunction -- both patients and
researchers invariably
see through the double blind, according to Dr. Greenberg. When
patients
realize they are taking the real drug, the placebo effect is
especially strong,
particularly if they have read books and magazine articles
lauding the
medication.
At least one prominent psychiatrist, Walter Brown of Brown
University, has
proposed that placebo pills be the initial treatment for
patients with mild or
moderate depression. Physicians would tell patients, in
effect, "These pills
have no active ingredients, but studies show they help in many
cases." Dr.
Brown cites evidence that patients will respond to placebo
pills even after
being told this.
A more time-tested method for achieving relief was highlighted
by a recent
study at Duke University. Researchers examined 87 depressed,
elderly
patients, about half of whom were receiving psychotherapy,
antidepressants
or a combination of the two. The best predictor of improvement
was not
these expensive remedies but the "religiosity" of the patient.
The psychiatrist Jerome Frank warned in his classic book
"Persuasion and
Healing" that the placebo effect might be the primary factor
underlying all
psychiatric remedies. The latest research supports Dr. Frank's
finding:
psychiatrists, psychologists and other "scientific" healers
are really exploiting
the power of human belief, just as shamans and witch doctors
do.
John Horgan is the author of ``The End of Science'' and the forthcoming
``The Undiscovered Mind.''
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