Jewish World Review May 14, 2002 / 3 Sivan, 5762
I finally mentioned the matter to my doctor who reminded me, correctly, that this was occurring right around the time of year when my mother had died. Still, she explained, the sleep problems were a sign of depression. "I'll write you a prescription for Prozac," she said.
I trust my doctor, but I was not depressed and I politely refused her solution of the wildly popular anti-depressant. In contrast, realizing that the sleep problems were likely just another signal that I missed my mom did help, and within weeks I was sawing away per usual.
Of course if the problem returns, I could always try a sugar pill.
That's right. After decades of use and thousands of clinical trials, and surely much to the chagrin of the companies making billions from anti-depressants, it's now clear that placebos are as effective as or even more effective than the popular drugs Prozac, Zoloft and Paxil in treating depression. Amazingly, when a person in a clinical trial is (unknowingly) given a sugar pill for his depression, even his brain chemistry changes the same way as it does with the real medicine.
As the bombshell Washington Post headline put it this week, "Against Depression, a Sugar Pill is Hard to Beat." The study, conducted by Seattle psychiatrist Arif Khan, analyzed 96 antidepressant trials conducted by drug companies in the process of getting Food and Drug Administration approval between 1979 and 1996. In more than half of them, the effect of the drug was not any different than the effect of the placebo. Khan found that the drug manufacturers had to run trials over and over again to get two that got positive results (an FDA minimum requirement).
Other studies show the same thing, the Post noted. In one reported last month, Zoloft, the herbal remedy St. John's Wort and placebos were compared. St. John's Wort cured the depression of 24 percent of those who took it, Zoloft cured 25 percent and the sugar pill 32 percent. And guess what? Once the newly happy folks on the placebos found out that that's what they were taking, their depression returned.
Researchers admit they don't really know exactly why antidepressants work, or don't work. Nor are these new studies, and assessments of the old ones, necessarily definitive. And anyway a curative "placebo effect," even for physical illness, has long been observed in medical literature. But the finding here is little short of astonishing. And it clearly suggests that the effectiveness of drugs designed to address a descriptive malady like depression depend a lot on how we feel about the pills we're taking, which in turns suggests that we have far more control over our feelings and our mental health than some folks might like to admit.
This is not to suggest a "you're-depressed -get-over-it" approach. Anybody who has known someone who has gone through a severe depression knows how truly debilitating it can be, and if pharmaceuticals can sometimes help it's a blessing they are there. At the same time, it is by no means clear that drugs can typically relieve the severely clinically depressed who really are at risk of hurting themselves or others.
But it's also obvious now that there are a lot of "worried well" popping pills to feel "happy," instead of engaging or wrestling with the issues that disturb them and growing and learning and becoming better people through that process. It's also clear there are a lot of doctors handing out the pills practically like breath mints. Fully nine out of 10 people of the growing number who see a doctor for treatment of depression are prescribed a medication, the Post reported. (I can't help but wonder where our art and literature and music would be if instead of creating through their angst and melancholy some of our greatest creators popped a pill instead?)
It may even be that some people are simply too wrapped up in
themselves and their own "angst," focusing inward to an unhealthy
extent instead of outward. And no medication can help that. In any
event, hundreds of millions of prescriptions have been written for
the wildly popular anti-depressants, and unfortunately they are
hardly the only medicine overprescribed in America today. In fact
the incredible "success" of Prozac and its cousins may actually be a
symptom of a greater ill - that we Americans like easy answers,
especially if they come in the form of pills.