Seems that she makes the opposite point she's trying to argue. The studies show the antidepressants are no better than placebo in mild to moderate depression. Therefore, they don't work, OTHER than functioning as a placebo. Yes, we all know the placebo effect is real, about 20% of people improve with a sugar pill. So, I guess she's arguing that the antidepressant is just a substitute for the sugar pill, and therefore effective in that regard. Why not save expense and side-effects and just give patients the sugar pill instead, when they have mild to moderate depression? Or better yet, prescribe exercise, bright light therapy, nutrition, abstinence from CNS depressants, and healthy sleep habits instead.
The evidence for a physiologic/anatomical cause of the symptoms of depression is overwhelming. The vegetative symptoms of severe depression; generalized anxiety, appetite disturbance and, the hallmark, sleep disturbance, all point to an abnormal "hypervigilant" state probably mediated through the hypothalamic, pituitary, adrenal axis. The genetic predisposition for depression and the evidence that permanent changes in the brain may progress with frequent bouts of severe depression also point to a common physiologic pathway. Having experienced the acute onset of 2 bouts of severe depression, complete with all the vegetative symptoms, I can tell you from personal experience that you KNOW something has changed in the way your brain and body are functioning. It's if an alien has invaded your body, taken control and tucked your old "self" away in a closet somewhere. I couldn't say that any of the antidepressants that I tried had a profound effect on recovery, it was 6 months of hell, and then about 2 years of discomfort before remission in both cases. However, now I think I'm on a combination drug therapy that I feel is more effective in keeping me in remission. Part of the issue may have been that I'm more bipolar with mainly depressive mood, rather than a true unipolar depressive type.

Man... I wish she would put error bars on these things. I have no idea what variability in a GAS looks like. Worse, it's very hard for me to assess what clinician bias can do to these data. For example, what the person discussing "side effects" of a placebo might insinuate could have a relatively substantial impact on these data. Interpreting data of these sort is always a challenge.

I'm honestly more impressed with her anecdata. "Most of us know." "Anyone working with patients can see." That sort of stuff. Clearly she's worked with people, and has been a successful "healer." I'm just not yet convinced chemicals have as much to do with it as relationships with therapists and patient compliance. The data just don't seem to speak to that. In fact, little things like the lag in the efficacy she mentioned provide evidence against our understanding of how these chemicals work.

Okay... I haven't finished the video, but I'll give you a play by play anyway. It's not my field (I study sensory systems) so if there are any clinicians in the audience, please forgive my ignorance.

First plot: The effect she's talking about is an extrapolation from a linear model with presumably assumed uniform variance along the independent axis. If you look at the actual underlying data, presumably notated with open and filled bubbles (no mention of what size means, but probably number of samples) you see that there is a lot of "effect" extrapolated from the model despite very little obvious trend in that part of the data. In fact, there are only two or three open bubbles at all on that part of the chart presumably because it was viewed as unethical to treat severely depressed patients with placebos. Further, there is a huge (relatively speaking) variability in the efficacy among severely depressed patients treated with the drugs. This is a symptom of one of the root problems which is that clinical modeling is typically very weak. The models are often simplified not because it is appropriate or useful, but rather because it is the way that particular researcher knows how to model data.

The a priori linkage between score on some survey and a response to some chemical is, IMO, tenuous at best. Given an argument from correlation that seems to lean heavily on a magic data point or two does little to change it. To give you a sense of how tenuous this data is, consider instead fitting the lines through only the data where the effect is considered "large." As an experiment, pull up the chart, and do a "chi by eye" fit of a line through the white dots, and a line through the dark dots, but only those dots to the right of the "severe depression" threshold line. Notice that the white line would then have a much steeper slope (stronger correlation) and the dark line would have almost no correlation (that data looks pretty isotropic to me).

Alright... that's enough for one comment. Next plot please...

Thought some of you might be interested in this video from a lecture at Johns Hopkins Medicine. It's not as glossy as 60 Minutes and it can be a little dry at times, but it gives an alternate view on Kirsch's placebo research.

http://videosift.com/video/Antidepressants-and-Placebo-Controversies-Johns-Hopkins

I'm not sure if you're serious or not, but there was a study at MIT that showed more expensive placebos were more effective than less expensive placebos. That is, there was a reliable effect of the cost of the sugar pill. I know... depressing right? That's just what we need to tell the drug companies. "You don't even need to do research... just mark up the sugar until it starts working."

>> ^dag:

Yes, but you need to pay until it hurts for the placebo effect to work.>> ^eric3579:
I hope at some point I'm taking sugar pills that work. I'm guessing they are a hell of a lot cheaper.

Your video, 60 minutes - depression and the placebo effect, has made it into the Top 15 New Videos listing. Congratulations on your achievement. For your contribution you have been awarded 1 Power Point.

>> ^DuoJet:

This is total, f cking, bullsh t. I tried a number of different medications before I found the right one for me. Some of the medications I tried did nothing, some caused unwanted side effects, only one got me where I wanted to be.
For me the difference has not been modest, but life-changing.
Friends have described the similar experiences.
Do not stop taking your anti-depressants based on this report.


My experience is similar to yours but let us not dismiss these findings just because they are not what we want to hear.

Assuming these findings are correct for a moment, it could be that you and I are the sort of people who genuinely benefit from the drugs whereas the vast majority of people who are given the drugs are not and are merely benefiting from placebo.

Congratulations! Your comment has just received enough votes from the community to earn you 1 Power Point. Thank you for your quality contribution to VideoSift.

Comment hidden because you are ignoring dag. (show it anyway)

Yes, but you need to pay until it hurts for the placebo effect to work.>> ^eric3579:

I hope at some point I'm taking sugar pills that work. I'm guessing they are a hell of a lot cheaper.

>> ^DuoJet:

I am one of those people, and I experience genuine physiological effects from these drugs...


The physiological effects of a placebo are no less "genuine" than that of drugs.
Also, your own perceptual experience of your medication's effects lends no scientific credibility to your position that the chemicals are responsible.

I'm glad you found something that works though, I doubt I ever will.

I'll just add some nuance to your assertion below. The issue is not so much that depression is "misdiagnosed." The issue is that depression doesn't have a known physiological cause. That is, there is no anatomical or physiological marker for depression. It's a behaviorally defined disorder. That means it is entirely possible (even likely) that multiple patients all suffering from "depression" (i.e. exhibiting the behavioral symptoms of depression, thus being properly diagnosed) could be suffering as a result of differing physiological problems.

Almost all psychiatric disorders (other than maybe Parkinson's and some other known neurological malfunctions) have this issue. The problem I have with this is our readiness to prescribe physiological interventions for conditions that can't be diagnosed physiologically. While many of these substances are relatively benign, some have the potential to cause extremely problematic side effects (e.g. acute suicidal urges). The real work is going to be in finding better mechanistic level diagnostics.

In the mean time, I think more conservative treatment protocols are warranted. If sugar pills show some efficacy, why not start with those? You could still ramp up to an SSRI or the like when the sugar pill is shown to be ineffective in that patient. Better still are behavioral therapies, e.g. exercise or sleeping schedule changes. At the very least, I think they should be prescribed along with and emphasized just as much as the pills and counseling.

Longterm, I think pharmacological interventions into the brain are somewhat misguided. Serotonin receptors, for instance, are expressed all over your brain. I think more promising are the newer treatments like deep brain stimulation. It has been shown to be extremely effective in disorders like Parkinson's, and trials are already underway in the treatment of depression. Not only do I think the treatment will ultimately be more effective, I also think research into that sort of treatment is more likely to bear fruit in understanding the mechanistic underpinnings of these disorders. Hopefully that will lead to better sub classifications of people exhibiting depressive behavior.

>> ^DuoJet:

I'm inclined to believe that, as is often suggested, depression is very commonly misdiagnosed. This would surely introduce "extraneous variables" into placebo studies as well.

Berticus, I appreciate the folly of anecdotal evidence, and I'm very aware, and not skeptical of, the placebo effect.

My problem with the report is this assertion:

"oh, yes, people get better when they are taking da drug, but it's not the chemical ingredients that are making them better"

I am one of those people, and I experience genuine physiological effects from these drugs, including one or more effects that actually make life livable.

I'm inclined to believe that, as is often suggested, depression is very commonly misdiagnosed. This would surely introduce "extraneous variables" into placebo studies as well.

This video has been nominated as a duplicate of this video by Norsuelefantti. If this nomination is seconded with *isdupe, the video will be killed and its votes transferred to the original.

*dupeof=http://videosift.com/video/60-minutes-depression-and-the-placebo-effect

Thank you, kind sir.

In reply to this comment by dag:
*promote