Earlier this week I posted a video by Dr. Peter Breggin where he discussed “chemical imbalances” in the brain, and how this message is more hype and marketing than it is good science. Today Dr. Breggin discusses how psychiatric drugs “work,” something that millions of current patients of psychiatric drugs should be very interested in learning.
While Dr. Breggin offers the biology of why these drugs supposedly “work,” another important point not discussed on this video that should be noted is the placebo effect. Over the years, many people I know who have used psychiatric drugs have sworn to me how much better they have felt while using a particular drug, always attributing the positive change to the drug, while completely oblivious to how the placebo effect might have played into the change. Placebo effects happen all the time, and they are regularly seen in patients who begin using a psychiatric drug because the patient desperately wants to see positive change. What this means is that the first good thing that happens after the patient begins using (i.e. spending a pleasant day with a friend) is immediately linked to the drug. While it is true the drug may have helped caused the change (although this is unlikely), the more accurate reason why the change occurred probably has more to do with these two things:
A) The patient is looking for the positive effects of the drugs, and therefore “sees” those changes while minimizing or ignoring the negative aspects of the day, and
B) Extraneous variables caused the change – for example, that pleasant day with a friend might have been that way because it was a really nice, sunny day (which usually makes us all a little happier!).
The reality is that it’s very, very difficult to establish cause-effect changes in social and behavioral science, mostly because there are countless competing reasons and factors that simply cannot be controlled when measuring change (we call these extraneous variables). In the example I provided above, the patient who had a great day with a friend on a nice summer day might not have had that same experience on a cold, icy day – even if he was using an anti-depressant medication!
The placebo effect immediately creates positive expectations, which is actually a good thing in many ways. The problem, however, is that it often muddies research results since it is almost impossible to control for when examining the efficacy of various drugs. Interestingly, placebos have largely been right on par with anti-depressants when measuring efficacy rates, meaning that when patients do not know they are taking a sugar pill they regularly report the same positive feelings (and sometimes even more) when compared to taking the real medications. It’s just too bad we can’t ethically offer people harmless placebo pills, because if we could we might see a lot more people feeling happier – and without any side effects!