Ingesting placebo

Elizabeth A. Wilson, The University of New South Wales

It has become a commonplace claim that antidepressant medications (specifically the SSRI and SNRI class of drugs) are no more effective than placebo.  Starting with an analysis of the “placebo wars” in the literature on antidepressant efficacy, this paper argues that debates about antidepressant drugs are now structured according to strongly bifurcated political allegiances.  However, these agonistic viewpoints don’t contribute to either conceptual and clinical innovation.  This essay is an attempt to find a way round the imperative to cleave antidepressant effects into separate domains (pharmacology or suggestion; drug or placebo).  It considers some recent clinical research on antidepressants and placebo from the Neuropsychiatric Institute at UCLA.  I show how data from two recent publications (as below) support the notion that it is the relation between a drug and a placebo that is at the centre of antidepressant action in clinical trials.  Rather than having to nominate either the drug or the placebo as the sole author of antidepressant effects, and rather than having to reject either the drug or the placebo as a clinical hoax, we may now be in a position to model a system of efficacy in which drug and placebo, molecules and milieu are properly, happily entangled.

Leuchter, Andrew, Ian Cook, Elise Witte, Melinda Morgan, and Michelle Abrams. 2002. Changes in brain function of depressed subjects during treatment with placebo. American Journal of Psychiatry 159(1): 122–129.

Hunter, Aimee, Andrew Leuchter, Melinda Morgan, and Ian Cook. 2006. Changes in brain function (quantitative EEG cordance) during placebo lead-in and treatment outcomes in clinical trials for major depression. American Journal of Psychiatry 163(8): 1426–1432.