Neither anti-depression drugs nor psychotherapy are more effective in treating depression than inactive placebo pills, US scientists have observed in their latest clinical trials.
The authors of the work in the Journal of Clinical Psychiatry emphasize, however, that their results should be interpreted with caution, among others because the effects of various treatments may depend on the gender and race of patients with depression. In addition, the research covered a relatively small number of people and must be repeated on a larger group of patients.
There have already been reports that people with depression undergoing actual therapy – such as those receiving antidepressants or St. John’s wort – often do not get better than placebo-treated patients.
In the latest research, scientists from Adelphi University in Garden City (New York State) randomly assigned 156 patients from the so-called major depression to one of three groups: the first daily for 16 weeks took a modern antidepressant containing sertraline, classified as serotonin reuptake inhibitors (SSRI), the second attended psychotherapy called supportive-expressive – twice a week for a month, and then once a week for the next three months, and a third in the same period took an inactive placebo. When sertraline was unsuccessful after 8 weeks, patients were switched to venlafaxine from the group of norepinephrine-serotonin reuptake inhibitors (SNRIs). A similar strategy was used in patients taking placebo – when there was no improvement, one placebo was replaced with another.
It turned out that after 16 weeks, the three study groups did not differ in terms of therapeutic effects.
Antidepressants worked in 31 percent. patients using them. This was expressed as a drop in the number of points on the standard depression severity rating scale.
28 percent achieved similar effects. patients with depression in the group undergoing psychotherapy and 24% from the placebo group. The differences between the groups were too small to be statistically significant.
“The results of this research surprised me. This is not what I expected, ”comments the lead author of the work, Jacques P. Barber from Adelphi University.
In an interview with Reuters, however, the researcher points out that this does not mean that antidepressant treatments are pointless.
First, using a placebo in clinical trials “is not the same as not receiving any treatment,” says Barber. Patients from this group have constant contact with medical workers who ask them questions about symptoms of depression and well-being. For some people, this interest may be important, which could explain the therapeutic placebo effect observed in the studies.
In addition, at least some placebo users believe they are getting real treatment. And some previous studies have suggested that people’s belief in the effectiveness of the treatments they receive is critical to improving their health, Barber points out.
In addition, his team observed that people may react differently to different types of antidepressant therapy depending on, for example, gender and race.
It turned out, for example, that African-Americans, who made up 45 percent of of all respondents, can improve faster with psychotherapy than with drugs or placebo. Placebo worked best in white men, and all three methods had similar results in black women. Only white women showed results consistent with the predictions, ie faster response to anti-depression drugs and psychotherapy than to placebo.
But Barber points out that the latest research has looked at a fairly small number of people and that more work is needed to assess whether gender and race differences really exist.
“These results are interesting, but they need to be interpreted with some caution,” comments Dr. David Mischoulon of Harvard Medical School, who was not participating in the study.
The researcher warns against hasty conclusions that “nothing works for depression”. “I think the opposite is true. Rather, everything seems to work to some extent here, ”he comments to Reuters.
Dr. Mischoulon agrees with Barber that administering a placebo in clinical trials is actually not a complete absence of treatment.
He also points out that the latest work uses only two drugs for depression and one type of psychotherapy. Therefore, it is not known whether these results can be applied to other medications and types of psychotherapy.
In his opinion, people with depression should discuss the advantages and disadvantages of all therapeutic options, such as medications and various forms of psychotherapy, with their doctor. “I try to offer my patients the widest possible range of options because they can potentially all help,” said Dr. Mischoulon, who is also testing alternative treatments for depression, including fish fat supplements and acupuncture.