Why does the placebo response work in treating depression?

September 11, 2014 by Mark Wheeler, University of California, Los Angeles
Why does the placebo response work in treating depression?
Dr. Andrew Leuchter

(Medical Xpress)—In the past three decades, the power of placebos has gone through the roof in treating major depressive disorder. In clinical trials for treating depression over that period of time, researchers have reported significant increases in patient's response rates to placebos—the simple sugar pills given to patients who think that it may be actual medication.

New research conducted by UCLA psychiatrists helps explain how placebos can have such a powerful effect on depression.

"In short," said Andrew Leuchter, the study's first author and a professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior, "if you think a pill is going to work, it probably will."

The UCLA researchers examined three forms of treatment. One was supportive care in which a therapist assessed the patient's risk and symptoms, and provided emotional support and encouragement but refrained from providing solutions to the patient's issues that might result in specific therapeutic effects. The other two treatments provided the same type of therapy, but patients also received either medication or placebos.

The researchers found that treatment that incorporating either type of pill—real medication or placebo—yielded better outcomes than supportive care alone. Further, the success of the placebo treatment was closely correlated to people's expectations before they began treatment. Those who believed that medication was likely to help them were much more likely to respond to placebos. Their belief in the effectiveness of medication was not related to the likelihood of benefitting from medication, however.

"Our study indicates that belief in 'the power of the pill' uniquely drives the , while medications are likely to work regardless of patients' belief in their effectiveness," Leuchter said.

The study appears in the current online edition of the British Journal of Psychiatry.

At the beginning and end of the study, patients were asked to complete the Hamilton Rating Scale for Depression, giving researchers a quantitative assessment of how their depression levels changed during treatment. Those who received and supportive care improved an average of 46 percent, patients who received placebos and supportive care improved an average of 36 percent, and those who received supportive care alone improved an average of just 5 percent.

"Interestingly, while we found that medication was more effective than placebo, the difference was modest," Leuchter said.

The researchers also found that people who received supportive care alone were more likely to discontinue treatment early than those who received pills.

People with have a persistent low mood, low self-esteem and a loss of pleasure in things they once enjoyed. The disorder can be disabling, and it can affect a person's family, work or school life, sleeping and eating habits, and overall health.

In the double-blind study, 88 people ages 18 to 65 who had been diagnosed with depression were given eight weeks of treatment. Twenty received supportive care alone, 29 received a placebo with supportive care and 39 received actual medication with supportive care.

The researchers measured the ' expectations for how effective they thought medication and general would be, as well as their impressions of the strength of their relationship with the supportive care provider.

"These results suggest a unique role for people's expectations about their medication in engendering a placebo response," Leuchter said. "Higher expectations of medication effectiveness predicted an improvement in placebo-treated subjects, and it's important to note that people's expectations about how effective a medication may be were already formed before they entered the trial."

Leuchter said the research indicates that factors such as direct-to-consumer advertising may be shaping peoples' attitudes about medication. "It may not be an accident that placebo response rates have soared at the same time the pharmaceutical companies are spending $10 billion a year on consumer advertising."

Explore further: Does the brain 'remember' antidepressants?

More information: Andrew F. Leuchter, Aimee M. Hunter, Molly Tartter, and Ian A. Cook. "Role of pill-taking, expectation and therapeutic alliance in the placebo response in clinical trials for major depression." BJP bjp.bp.113.140343; published ahead of print September 11, 2014, DOI: 10.1192/bjp.bp.113.140343

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5 / 5 (2) Sep 12, 2014
Antidepressants dont work for everyone. I know people who have gone off them (including myself) because nothing changed while they were taking them. You just feel numb. Exercise and sunshine can make a difference.
4 / 5 (1) Sep 12, 2014
While those things help, they still don't cure it.
3 / 5 (2) Sep 13, 2014
Get up, have a shower, put on clean clothes and eat breakfast, EVERY day. This preps you to be "ready to face the world"... not ready today.. OK but unless you prep you never will be. Sitting around in bed clothes unwashed and watching TV doesn't help.

Having clean clothes meant you had to wash clothes, maybe walking outside to a clothesline etc... it all helps. next the letterbox and then.. who knows

Taking a pill will teach your body and brain to take a pill, nothing more nothing less.
5 / 5 (2) Sep 13, 2014
Sorry Sinister meant a 5 not a 4. There should be an edit function on scores same as there is on comments. Actually will suggest just that to Physorg :)
5 / 5 (2) Sep 13, 2014
Posted this as a recommendation to Physorg..

Be nice if we could edit a Star rating the same as comments. I clicked a star rating by accident but cannot edit it at all.
not rated yet Sep 13, 2014
OZGuy You are so right, can't argue with that. Don't really agree with this article. And thanks mate, you are a champ.

No worries, I do the same thing sometimes with the ratings. :)
not rated yet Sep 13, 2014
Snag is that there are both 'Reactive' and 'Endogenous' modes of depression and, from what I've seen, having one often leads to developing the other.

Now, 'Talking Therapy' may help with 'Reactive' aspects. Just having some-one actually listen with insight for more than an MD/GP's five minute consult can't hurt. And, refreshing mechanisms for coping must help. If the placebo effect can be used, great !

These don't touch the Endogenous aspects, though. Talking at that is like praying over a child stricken by 'Type 1 Diabetes'. And offering a placebo is no better than homeopathy...

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