But according to medical researcher Jeremy Howick, antidepressants work through the placebo effect.
The placebo effect refers to when symptoms of a condition improve even when using a nonactive treatment. It is said that this occurs due to psychological factors, such as expectations or classical conditioning.
In clinical trials, a placebo is an inactive substance that looks like the drug or treatment being tested. Placebos are used to help scientists understand the effects of a drug or treatment on a certain condition. For example, some participants in a study may be given a new drug to lower cholesterol, while others get a placebo.
In a recent article on Psychology Today, Howick sought to debunk myths about the placebo effect.
Howick caused a stir on Facebook when he mentioned that the placebo effect is effective for mild or moderate depression. Howick believes there is a misunderstanding in how people perceive the placebo effect. It goes like this: If the placebo effect is real, then depression is not.
But the fact that various studies indicate that the placebo effect can help does not mean that mild or moderate depression is not awful or unreal. It just means that the placebo effect is real.
Most people seem to believe that antidepressants are better than placebos. However, researchers have long been questioning this assumption.
In a 2018 study published in the journal The Lancet, researchers compared the effects of different antidepressant drugs with each other and with placebo. They reported that antidepressants were more effective than a placebo in adults with major depressive disorder. The study was widely reported in the news and is one of the main studies used to justify the use of antidepressants.
However, a study published the following year found serious flaws with the 2018 study. Its first main problem was publication bias. This means that many antidepressant trials, especially those where antidepressants weren't shown to have a positive effect, are usually not published.
The 2018 study also showed that the benefits of antidepressants were smaller in unpublished studies. However, the researchers did not note this significant limitation in their conclusion. The 2018 study also failed to consider the effect of "placebo run-in" periods.
Before a clinical trial begins, researchers give study participants placebos for a few weeks. They then exclude "placebo responders," or participants who benefited from the placebo. But excluding placebo responders inflates the benefits of the drug or treatment being tested compared with a placebo.
Overall, these issues suggest that the benefits of antidepressants for mild to moderate depression might not be as clinically significant as scientists previously thought.
Howick also noted that most people think of placebos as sugar pills that don't actually contain anything "real." However, there is so much more to the placebo effect than placebo pills. Placebos come in many forms, including saltwater injections and talking therapies.
If antidepressant drugs work mostly because of the placebo effect, should physicians start giving their patients placebo pills and tell them they are "real" drugs? Howick does not think so as that would be unethical.
However, Howick also does not think it a good idea to keep doling out antidepressants to patients dealing with depression and other mental health problems.
"If there were no harms or costs of the drugs, that might be a good idea," he wrote. However, antidepressants can harm patients. The drugs are known to cause sleep problems, headaches, weight gain, palpitations, agitation, confusion, diarrhea, blurred vision and dizziness.
All things considered, Howick believes patients do not need a placebo pill to experience the placebo effect. Positive and emphatic care from physicians and medical professionals can go a long way toward helping patients deal with symptoms of mild to moderate depression.
Safe, natural treatments for mild to moderate depression like exercise, cognitive-behavioral therapy (CBT) and yoga can also help patients. (Related: Yoga as complementary medicine: How yoga can support your mental and physical health.)
Watch this video of Dr. Peter Breggin discussing the link between antidepressant use and violence, suicide and crime.
This video is from the Peter R Breggin MD History channel on Brighteon.com.