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Placebos don't contain any active ingredients, but time and time again, research has shown that they do have the potential to lead to real changes in health. What role could the placebo effect play in the treatment of depression?

Say you've been prescribed a particular antidepressant and want to find out how effective it is. Should you explore peer-reviewed studies in the process, you'll see that your antidepressant will have been compared to a placebo as well as to other drugs to determine how well it works to fight depression. Placebos are, of course, "drugs" that do not contain any active ingredients, and that shouldn't, logically, be able to have any effect at all, so this makes sense. But what if placebos could — themselves — also play a role in treating depression? 

The thought alone may be a little insulting, reminiscent of a "depression is all in the head" mindset. The science, however, is fascinating. 

Do placebos have the potential to treat depression?

A 1994 paper noted that it isn't uncommon for depressed patients to respond to placebo treatment — that is, for them to start feeling better when they take a placebo. In fact, between 30 and 40 percent of depressed people taking a placebo start noticing improvements in their depressive symptoms, consistently, across different studies. While people who have moderate to severe depression will typically fare better on an actual antidepressant, around half of mildly depressed patients respond well to placebo treatment. This rate represents just about the same number of people who actually notice symptom relief with a real antidepressant. 

The lone author of this research paper went on to propose that most depressed people should be put on placebo treatment rather than antidepressants for four to six weeks to see if this makes a sufficient difference. If a placebo can be just as effective as the real thing, it would eliminate a lot of side effects and save healthcare systems a lot of money too.

Is this insulting? Unethical? Maybe. Probably. A more recent and much more serious study, published in 2015 by a team of people who had been studying placebos for a very long time, once again examined the possibility that the placebo effect can play a role in the treatment of depression, however, and it reached some interesting results. 

First off, it mentions that response rates to placebos are high across many different medical conditions, Parkinson's disease included. Placebo treatment is by no means the same as simply receiving no treatment at all. A placebo can cause changes in metabolism just like a real medication can, though less intense changes. It can also, in fact, lead to changes in brain chemistry of the kind necessary to relieve major depressive disorder. (The same kinds of changes can explain why a placebo can lead to pain relief.)

In first portion of the study, all participants were offered a placebo — but only one group was told it was a placebo, while the other was under the impression they were receiving a fast-acting antidepressant medication. The two groups were then switched. The people who thought they were taking an antidepressant did better, and showed changes in brain chemistry (specifically the opioid system), compared to the ones who knew they were taking placebos. 

But wait, there's more

After this study's trial with placebos was done, all participants were put on a real antidepressant — typically one from the SSRI class. How did they do once this portion of the study was reached? Well, people who responded well to placebo treatment for depression also responded better than those who didn't to true antidepressants, the study found. 

One of the authors of the study said:

"These results suggest that some people are more responsive to the intention to treat their depression, and may do better if psychotherapies or cognitive therapies that enhance the clinician-patient relationship are incorporated into their care as well as antidepressant medications. We need to find out how to enhance the natural resiliency that some people appear to have."

What can you learn from this? Well, on one level, treatment is more likely to work for you if you believe it will work for you, and so, conversely, less likely to work if you believe it won't. These fascinating study results don't mean that anyone is suggesting that you take sugar pills instead of antidepressants if you are suffering from severe major depressive disorder. They do point to the idea that, whatever treatment for depression you are receiving, you may fare better if you have hope that you will recover from depression — and feel supported in the process.

With this mindset, you may coach your own brain, unconsciously, into having the same kind of effect a tried-and-tested antidepressant medication could have. 

The take-away tips? I interpret them like this. If you get weird vibes from your doctor or therapist, it's time to find healthcare providers you do have trust in, as this may mean your long-term outcome is better. If you believe that making changes in your routine, like getting out regularly to socialize, will help you, these steps are quite likely to do just that. If your informal support network is strong and constantly gives you feedback that they care about you, love you, and believe you will overcome depression, this may rub off on you and your brain too. 

We don't have to take an actual placebo to benefit from the lessons learned about the placebo effect in the treatment of depression!

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