The Power of Placebo

Reframing and contextualizing research on prescription antidepressants

St John's Wort in bloomDr. Mahalia Freed, ND

So, the jig is up: An international meta-analysis on prescription antidepressants conclusively found them to be as effective as placebo (Kirsch & Sapirstein 1998.) Over a decade later, the hush-up is getting frayed around the edges, as evidenced by the recent article in Newsweek, titled, “The Depressing News About Antidepressants” (http://www.newsweek.com/id/232781).

According to Kirsch’s findings, which were confirmed again in 2008, careful analysis of all eligible studies on antidepressants reveals that prescription antidepressants are clinically as effective as placebo for mild to moderate depression (Kirsch & Sapirstein 1998; Kirsch et al 2008). These findings do not mean prescription antidepressants are “not effective”, only that the placebo effect is powerful, and the drugs’ perceived effectiveness may be attributable to the power of our belief in the medicine, rather than the medicine itself.

As I have written before, your beliefs are powerful in directing your healing. Again, I refer to Dr. Bruce Lipton, cell biologist and epigeneticist. In describing how receptors in our cell membranes interpret environmental conditions outside the cell – effectively issuing directives to cell about what is going on in its environment so that it can respond optimally – he says the following: “because receptors can read energy fields, the notion that only physical molecules can impact cell physiology is outmoded. Biological behaviour can be controlled by invisible forces, including thought, as well as it can be controlled by physical molecules like penicillin” (emphasis mine, 2008: 53-54).

I love how the idea that our thoughts can influence our physical bodies is no longer a flakey statement, but is borne out in trial after trial, meta-analysis after meta-analysis. This is the beauty of the new findings, disappointing and discomfiting though they may be for some.

Indeed, there are people who are up in arms about publicizing this research because they don’t want to shake patients’ faith in medicine that produces clinical results. And, let me be clear: available research demonstrates that people who take prescription antidepressants get better. However, they get better in large part because they and their doctors believe they will. There are many other treatments we could have the same faith in, treatments with evidence that is just as strong if not stronger (see information box on St John’s Wort, for example).

Let us cultivate belief in the body’s ability to heal, and in the power of our thoughts to impact our health. Let us acknowledge that each person’s experience is unique, that each of us will respond optimally to a unique, individualized treatment approach. Sound familiar? That is because it is foundational to naturopathic medical care.

Interested in improving mood, naturally?  Interested in the power of your mind and body in healing? Consult with Dr Mahalia Freed, ND, for a treatment plan tailored to you.

Naturopathic Medicine and Depression

Naturopathic treatment of depression may include:

  • Counseling, and/or referral for psychotherapy
  • Addressing nutrient deficiencies
  • Optimizing diet
  • Supplements to correct imbalances or deficiencies
  • Individualized herbal formulae
  • Constitutional homeopathic medicine
  • Constitutional Chinese medicine
  • Lifestyle counseling: healthy sleep, exercise and stress management habits

St John’s Wort (Hypericum perfoliatum) is a great example of a natural medicine that works for mild to moderate depression. According to Cochrane’s rigorous 2008 meta-analysis, St John’s Wort is moderately more effective than placebo (Linde et al 2008). Given that this is based on the double-blind, placebo-control trial model – which by definition does not account for individual variation – we can expect even greater results when St John’s Wort is appropriately prescribed to an individual. And while I am as biased as any other clinician by my belief in the medicines I use, I consistently see people getting better when they incorporate naturopathic care – which may include St John’s Wort or any of the options listed above –  in addressing depression and anxiety.

Mahalia Freed is a Naturopathic Doctor in downtown Toronto. In her family practice, Dr Freed has a special focus in endocrinology, mental health, oncology, fertility, and perinatal care.

References:

Ankarberg P, Falkenstrom F. (2008) Treatment with antidepressants is primarily a psychological treatment. Psychotherapy Theory, Research, Practice, Training. 45(3), 329 –339.

Kirsch I, Sapirstein G. (1998). Listening to Prozac but Hearing Placebo: A Meta-Analysis of Antidepressant Medication. Prevention & Treatment, 1 (0002a).

Kirsch I, Deacon BJ, Huedo- Medina TB, Scoboria A, Moore TJ, et al. (2008) Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 5(2): e45.

Lipton, B (2005). The Biology of Belief. Vancouver, BC: Hay House, Inc.

Linde K, Berner MM, Kriston L. (2009). St John’s wort for major depression. Cochrane Database of Systematic Reviews 2008, Issue 4.

Rahimi R, Nikfar S, Abdollahi M. (2009). Efficacy and tolerability of Hypericum perforatum in major depressive disorder in comparison with selective serotonin reuptake inhibitors: A meta-analysis. Progress in Neuro-Psychopharmacology & Biological Psychiatry. 33, 118–127.

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