The doctor-patient relationship is critical to the placebo effect.
Irving Kirsch
Psychotherapy works, and some types of therapy have been shown to be much more effective than antidepressants over the long run.
Perhaps anti-depressants should be best reserved for the very extreme cases and, more importantly, for those who do not respond to alternative forms of interventions.
The big bulk of the response to antidepressants is the placebo response.
I do a lot of research on the placebo effect, not just in depression but in irritable bowel syndrome, pain, arthritis of the knee, migraine, asthma.
There seem to be many causes of depression. One cause is profound loss, grief. Economic hardship we know is linked to depression. We don't have a full picture.
One problem I have with drug companies is that they don't make all their data public.
Patients who trust their doctors and have a psychological expectation of getting better could trigger a reaction in their body.
There are a variety of techniques to help people change the kind of thinking that leads them to become depressed. These techniques are called cognitive behavioral therapy.
If doctors just spent more time with their patients so they felt more reassured, that might help.
Nocebos often cause a physical effect, but it's not a physically produced effect. What's the cause? In many cases, it's an unanswered question.
To someone who is not currently on anti-depressants, I would suggest trying other treatments first - for example, psychotherapy.
Antidepressants can have troubling side effects and are addictive for some people.
Perhaps 10 percent of patients who are prescribed antidepressants are really benefiting from the drugs' active ingredients.
There seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients.
The one thing we do know is that the chemical imbalance theory - the theory that people get depressed when they don't have enough serotonin in their brain - we know that that's wrong.
Anything that instills a sense of hope will at least temporarily help treat depression.
If you're taking an antidepressant, it's working, and you're not experiencing side effects, go on taking it. But if it's not working, or not working well enough, or if you have side effects you don't like, talk to your doctor about an alternative approach.
Depression comes back over time in about 90 percent of people on antidepressants. Studies show that relapses are far less common when people are treated with psychotherapy.
