SOUL + BODY: Placebos for Depression?

In January we learned from the New England Journal of Medicine that the pharmaceutical industry has not been publishing studies in which placebos beat or equaled antidepressants for effective treatment of depression. Over the course of a 20-year period, 74 studies of a dozen antidepressants were registered with the FDA — all of them paid for by the $21 billion pharmaceutical industry. Fully 37 of the 38 studies with positive results were published. Of the 36 studies that had negative or questionable results, 22 were not published, and of the 14 that were published, at least 11 mischaracterized the results and presented a negative as a positive.
    For example, Pfizer submitted five trials on its drug Zoloft to the FDA. The drug seemed to work better than the placebo in two of the trials, but in the other three, the placebo did just as well. Only the two favorable trials were published, and Pfizer discusses only the positive results in Zoloft’s literature for doctors, giving them an inflated view of the drug's effectiveness.
    This brings up some fascinating quandaries that could affect the way medicine is prescribed: We know that the effectiveness of any drug is partially due to a placebo effect. Even antibiotics tend to work better when we believe in them. We also know that the most important part of this placebo response is the belief of our doctors — when our doctors firmly believe in our medicines, our own belief is enhanced, and that makes the drugs more healing, regardless of the content of the medicines. Bloodletting is a good example of a dubious medicine that was somewhat effective for hundreds of years because doctors and patients believed in it. When Pfizer published only good news about Zoloft, the company boosted doctors’ confidence, and that confidence then made the drug more likely to help depressed patients.
    But what happens now that this confidence is shattered by the news that placebos work just as well as — or better than — pharmaceutical antidepressants in so many studies? As word spreads, will antidepressants suddenly be less effective? And if so, how does a doctor, in good conscience, prescribe a placebo for depression? And how does she not?

For more, see “Whole Body Happiness,” June 2006