3 ms·

The problem is the depression (clinical depression) is one of the most horrifyingly over-diagnosed diseases on the face of the planet. EVERYONE gets depressed.

by blhack 17y ago

The problem is the depression (clinical depression) is one of the most horrifyingly over-diagnosed diseases on the face of the planet. EVERYONE gets depressed. If people didn't, we'd be living in Utopia. When you hand some person who is having a crappy day a pill and say something like "this is full of magic chemicals that are going to make you feel better", their outlook on life improves, and they aren't depressed anymore! Clinical depression is different. Clinical depression is as much a real disease as anything else, and it cannot be treated with a placebo any more than a broken leg can. Real depression is not a psychological problem, it is a neurochemical one... Clinical depression does not even always manifest itself as feeling sad or anxious. It can present itself as bad memory, poor focus, decreased creativity...These things, while psychologicacl problems, have neurological causes. Yes, being sad does as well, but being sad is as easy to "cure" as being hungry. This is why the placebo worked.

randallsquared 17y ago
You seem to believe placebos do not affect actual medical problems. It's interesting in this regard that in placebo trials vs a gastric acid reducer (to treat ulcers), 48% of those taking a placebo improved, while 76% of those taking the real drug improved. The interesting part is that it's now known that ulcers are not caused by gastric acid, but by bacteria, so even the "real" drug here worked via placebo effect, but it did work for most patients. Edit: source: http://en.wikipedia.org/wiki/Placebo#Gastric_and_duodenal_ulcers http://en.wikipedia.org/wiki/Placebo#Gastric_and_duodenal_ul...
- yummyfajitas 17y ago
  That's probably due to the "leaky placebo" effect: if the placebo does something to you (e.g., gives you a headache, or other side effect), it makes you think it is really working.
ars 17y ago
That's what the drug companies want people to think. But it's not actually true. Even the type of depression you are talking about responds to placebos. And it responds very well to therapy, but barely at all to drugs - except that the drugs work well as placebos. It is a real condition - don't get me wrong, I'm not saying it isn't. It's just that the drugs don't do as much as people think they do. Most people when they first hear about placebos flatly refuse to believe they work as well as they do. But they do.
- blhack 17y ago
  I'm sorry, but no. If you're depressed, a placebo may improve your outlook and this improved outlook may present itself as a decrease in symptoms which, like I said, manifest psycologically, but unless you've got something to increase the amount of seratonin in your brain (which is used as a neurotransmitter...this is why depression can present as poor short-term memory, and poor focus) then you're fixing a physical problem with a psychological solution. If this makes somebody feel better, then fantastic for them! I'm sorry for being a bit combative about this...sever mania and depression is something that runs in my family, and debilitating depression and anxiety are something I've dealt with my entire life. Believe me, if there was a placebo-based solution to this, I would be the first person in line to get it... I don't mean to take offense, I know you don't mean any, but saying what you're saying is a bit akin to telling a cancer patient that they need to just get over it.
  - tsally 17y ago
    I don't mean to take offense, I know you don't mean any, but saying what you're saying is a bit akin to telling a cancer patient that they need to just get over it. I hear what you are saying, but I do not think he is being that harsh. The harshest part of his post is this: And it responds very well to therapy, but barely at all to drugs. It might be an overexageration, but the points he makes about the effectiveness of therapy and placebo are good ones. You of course are correct too; chemical imbalance is a valid factor to consider, and something that is correctable via drugs. I don't think you two are on opposite ends of a spectrum here. There is a wide range of possible solutions to depression. :-)
  - gruseom 17y ago
    You're missing the point. Placebos produce real physical effects, as real as those produced by non-placebos.
  - ars 17y ago
    > Believe me, if there was a placebo-based solution to this, I would be the first person in line to get it... If you are taking drugs for this, then you are in line already. Every one I have read about has studies showing it is only slightly more effective than placebos. I really am not trying to say the problem is not real. I'm only saying that placebos are far more effective than you realize. For example some quotes from wikipedia: "Notably, however, a recent Cochrane review of the efficacy of the SSRIs concluded that they were only slightly more effective than placebo for the treatment of people with depression." "A widely-reported meta-analysis combined 35 clinical trials submitted to the U.S. Food and Drug Administration (FDA) before licensing of four newer antidepressants (including the SSRIs paroxetine and fluoxetine, and two non-SSRI antidepressants nefazodone and venlafaxine). The authors found that although the antidepressants were statistically superior to placebo they did not exceed the NICE criteria for a 'clinically significant' effect. In particular they found that the effect size was very small for moderate depression but increased with severity reaching 'clinical significance' for very severe depression. The relationship between severity and efficacy was attributed to a reduction of the placebo effect in severely depressed patients, rather than an increase in the effect of the medication." (Especially note the last sentence.) Please don't understand this in reverse and assume people should/can do nothing. My point is placebos work, and people should make more use of them. Another thing: just because something is all in your head does not mean it's not real. People often assume that "since a placebo fixed it, it was not real to begin with". NO! That's is NOT the case. The problem was REAL, and the placebo fixed it.
astine 17y ago
bad memory, poor focus, decreased creativity... Oh No! I'm depressed. Help!

by blhack 17y ago

randallsquared 17y ago

You seem to believe placebos do not affect actual medical problems. It's interesting in this regard that in placebo trials vs a gastric acid reducer (to treat ulcers), 48% of those taking a placebo improved, while 76% of those taking the real drug improved. The interesting part is that it's now known that ulcers are not caused by gastric acid, but by bacteria, so even the "real" drug here worked via placebo effect, but it did work for most patients. Edit: source: http://en.wikipedia.org/wiki/Placebo#Gastric_and_duodenal_ulcers http://en.wikipedia.org/wiki/Placebo#Gastric_and_duodenal_ul...

yummyfajitas 17y ago
That's probably due to the "leaky placebo" effect: if the placebo does something to you (e.g., gives you a headache, or other side effect), it makes you think it is really working.

ars 17y ago

That's what the drug companies want people to think. But it's not actually true. Even the type of depression you are talking about responds to placebos. And it responds very well to therapy, but barely at all to drugs - except that the drugs work well as placebos. It is a real condition - don't get me wrong, I'm not saying it isn't. It's just that the drugs don't do as much as people think they do. Most people when they first hear about placebos flatly refuse to believe they work as well as they do. But they do.

blhack 17y ago
I'm sorry, but no. If you're depressed, a placebo may improve your outlook and this improved outlook may present itself as a decrease in symptoms which, like I said, manifest psycologically, but unless you've got something to increase the amount of seratonin in your brain (which is used as a neurotransmitter...this is why depression can present as poor short-term memory, and poor focus) then you're fixing a physical problem with a psychological solution. If this makes somebody feel better, then fantastic for them! I'm sorry for being a bit combative about this...sever mania and depression is something that runs in my family, and debilitating depression and anxiety are something I've dealt with my entire life. Believe me, if there was a placebo-based solution to this, I would be the first person in line to get it... I don't mean to take offense, I know you don't mean any, but saying what you're saying is a bit akin to telling a cancer patient that they need to just get over it.
- tsally 17y ago
  I don't mean to take offense, I know you don't mean any, but saying what you're saying is a bit akin to telling a cancer patient that they need to just get over it. I hear what you are saying, but I do not think he is being that harsh. The harshest part of his post is this: And it responds very well to therapy, but barely at all to drugs. It might be an overexageration, but the points he makes about the effectiveness of therapy and placebo are good ones. You of course are correct too; chemical imbalance is a valid factor to consider, and something that is correctable via drugs. I don't think you two are on opposite ends of a spectrum here. There is a wide range of possible solutions to depression. :-)
- gruseom 17y ago
  You're missing the point. Placebos produce real physical effects, as real as those produced by non-placebos.
- ars 17y ago
  > Believe me, if there was a placebo-based solution to this, I would be the first person in line to get it... If you are taking drugs for this, then you are in line already. Every one I have read about has studies showing it is only slightly more effective than placebos. I really am not trying to say the problem is not real. I'm only saying that placebos are far more effective than you realize. For example some quotes from wikipedia: "Notably, however, a recent Cochrane review of the efficacy of the SSRIs concluded that they were only slightly more effective than placebo for the treatment of people with depression." "A widely-reported meta-analysis combined 35 clinical trials submitted to the U.S. Food and Drug Administration (FDA) before licensing of four newer antidepressants (including the SSRIs paroxetine and fluoxetine, and two non-SSRI antidepressants nefazodone and venlafaxine). The authors found that although the antidepressants were statistically superior to placebo they did not exceed the NICE criteria for a 'clinically significant' effect. In particular they found that the effect size was very small for moderate depression but increased with severity reaching 'clinical significance' for very severe depression. The relationship between severity and efficacy was attributed to a reduction of the placebo effect in severely depressed patients, rather than an increase in the effect of the medication." (Especially note the last sentence.) Please don't understand this in reverse and assume people should/can do nothing. My point is placebos work, and people should make more use of them. Another thing: just because something is all in your head does not mean it's not real. People often assume that "since a placebo fixed it, it was not real to begin with". NO! That's is NOT the case. The problem was REAL, and the placebo fixed it.

astine 17y ago

bad memory, poor focus, decreased creativity... Oh No! I'm depressed. Help!