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Well not actually duds. Just good placebos. I’ve posted on this before and the data keeps coming in (See this article). The previous studies were extended to include the newer generation of antidepressant medication (fluoxetine, venlafaxine, nefazodone, and paroxetine).
All studies are biased and have an agenda. The Last Psychiatrist thinks that reporting on this story in the press is a move to promote antipsychotics for depression. I’d say that’ll probably happen.
The fact is, there is a large proportion of people who are depressed, and don’t want to think about psychotherapy or go through the process. They would prefer to take a pill. So, don’t worry, the pills will still be there. Only now, they’ve got worse side effects….
I’m a psychologist, and so my bias is towards psychotherapy. Very few of my patients, want, or take, medications. That said, I believe a signfiicant portion of people who take antidepressant medication would prefer psychotherapy if they were given the option. The majority of antidepressants that are prescribed in the nation are prescribed by the family doctor. Even though I work in “the sticks,” I am not hurting for business. However, there are a lot of psychologists in the field who struggle to build a practice. This is good news if it leads to more people recieving psychotherapy instead of medication; however, I don’t think this is very likely to occur. What’s more likely is a new set of biased data promoting the next wonder drug…. And again, this is OLD news. Studies like this have been around for 10 years, and now with the antidepressant patents running out… Suddenly, everybody takes notice….
Back in graduate school, I began to speculate about the nature of the placebo effect and psychotropic medication. I did many literature searches and read as many articles as I could find on the subject. What I discovered was the placebo effect is a powerful demonstration of the interaction between mind and body, and that the effects of many medications can be largely explained by this effect despite attempts at experimental rigor with double-blind experiments.
The review article by Kirsch and Sapirstein (1998) comparing the efficacy of antidepressant medication to placebo. One of their findings was that 75% of the effects of antidepressant medications could be explained by the placebo effect. Indeed, it was further suggested that the remaining 25% of the effect could be due to an active placebo effect. Meaning that because of side effects, the participants figured out they were in the active drug group, which enhanced their beliefs that they would benefit. Because of my research on cognitive dissonance, I speculated an additional possibility for why side effects enhance the placebo effect. When people suffer as a result of something that they believe will be helpful, this sets up an inconsistency of beliefs that must be resolved (”I’m taking this antidepressant medication, but I have trouble with sexual functioning now….But you know it’s worth it, because this is really helping me!”) So, the medication comes to be more valued because of the side effects, not in spite of them.
My dissertation was on cognitive dissonance (how people react and change their beliefs unconsciously when they are inconsistent). Cognitive dissonance theory might predict that people might believe that they are being helped more by a medication that actually has a slightly negative effect as opposed to a true placebo (such as a sugar pill). Additionally, dissonance would be increased by paying for the medication. Therefore, I would expect that people who pay for medication out of their pockets might have a somewhat better effect with medication. Generally, enhanced placebo effects from medications would need to a nuisance and not extremely negative. In other words, it’s difficult to develop a positive attitude about a medication with a serious negative effect. However, the more serious the condition, the greater the negative side effects could be, and the person could still come to the conclusion “I have these horrible side effects, but you know, it’s worth it because I feel better.”
Beliefs are powerful in all emotional disorders. If you truly believe something is beneficial, it usually will be. This also applies to some extent to a lot of physical disorders. Kirsh and others recommend that experimental procedures for medication be revised to include an active placebo group (a group that takes medication that causes some similar side effects), so that the true effectiveness of medication can be determined. I support this idea wholeheartedly.
Many children are on medication for Attention-Deficit/Hyperactivity Disorder. In many cases, medication can be avoided. There are a number of promising alternative treatments to medication, which I plan to discuss in future posts. In this post, I plan to discuss a most unusual and unexpected treatment.
The cerebellum is a part of the brain that lies roughly at the back of the brain and underneath the visual cortex. Early research found the cerebellum to be involved in balance, motor coordination, equilibrium, and posture. More recent research has implicated the cerebellum in a more broad range of cognitive and mental functioning, particularly attention, language and music processing, and other sensory processing.
Astronauts are known to develop a form of temporary dyslexia as a result of prolonged weightlessness, which is treated with having the astronauts perform a number of tasks involving balance and motor coordination. These techniques are thought to have their effects of cerebellar processing. The techniques were adapted for use with children suffering from dyslexia. A recent study provided astonishing evidence of the programs effectiveness, although future research remains to be conducted to validate the technique. Notably, the study found a great improvement in concentration for children with ADHD who were being treated for dyslexia. Improvements were found in 80% of the children involved in the program.
http://www.dore.co.uk/cure.aspx
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