The World Health Organization (WHO) has been observing its yearlong campaign of “Depression: let’s talk” and on April 7th, World Health Day stated that “depression is often overlooked and it is estimated that over 300 million people (over 50 million cases have been reported from India alone) are living with curable forms of clinical depression.” Depression medication mostly antidepressants work by altering the balance of certain chemicals in the brain. As with most such kind of medication, antidepressants although effective, also have several side effects
such as jitteriness, dry mouth and diarrhea, decreased sexual desire, nausea, insomnia, increased appetite and weight gain etc. Keeping in mind these side effects it’s of paramount importance to make use of alternative forms of medication with no or low side effects. Enter the wonder drug- the placebo!
The image above sums up the very essence of the term placebo effect, which is a remarkable phenomenon in which a placebo (fake treatment i.e. an inactive substance such as sugar, distilled water or saline solution) can sometimes improve a patient’s condition simply because the person has the expectation that it will be helpful.
Placebos have long been in use in India in the form of talismans and taaveez. While these have no direct effect they stimulate opiod receptors in the brain thereby reducing one’s anxiety and depression and therefore enhance overall well-being.
One of the more contemporary examples depicting to us the placebo effect would be the famous scene from the Harry Potter and the Half-blood Prince book/movie wherein Ronald Weasely is feeling down in the dumps and unsure of earning himself the coveted spot in his quidditch team Harry pretends to pour in a drop of liquid luck (felix felicis portion) into Ronald’s pumpkin juice. Now, Ronald assumes that he has drunk the liquid luck, charges ahead confidently in the quidditch trials and bags himself a spot. When accused of helping Ronald cheat Harry reveals to Hermione that he had not added anything to Ronald’s pumpkin juice and had just made him think that he had, to boost his confidence. (Well Harry Potter isn’t just fantasy!)
A research team headed by Dr. Jon-Kar Zubieta at University of Michigan and University of Utah funded by the National Institutes of Health (NIH) examined such effects of placebo in depression treatment. The scientists studied 35 people with major depression who were not on medication. In the first phase lasting 10 weeks of the study, the participants were divided into two groups and the first group was randomly assigned to receive placebo pills described as a potentially fast-acting antidepressant ( “this was the active placebo group”) and the other group was assigned with placebos described as having no antidepressant effects (“inactive placebo group”). Each group took the pill for a week and then switched to the other group’s medication. At the end of each week of treatment the respondents completed a questionnaire about their depression symptoms and also underwent PET brain scans to measure the activity of mu-opoid receptors (these are low during emotional arousal, stress, social rewards and depression). During these scans the active placebo group was given saline shots with the explanation that it might activate brain systems involved with mood improvement. The inactive placebo group received no such shot. In the second phase of the study all the participants were treated for 10 weeks with selective serotonin reuptake inhibitor antidepressants and their depression symptoms were monitored in the same manner as stated above. At the end of the study the respondents were briefed on placebos and the study design.
The active placebo group reported significantly lower depression symptoms as those in the inactive placebo group. These reduced symptoms and relatively quicker and more positive responses to the subsequent antidepressant treatment (than the inactive placebo group) were linked to the increased mu-opiod receptor brain activity which are associated with emotion and stress regulation (increased mu-opoid receptor activity denotes lower levels of emotional distress and elevated mood). Dr. Zubieta concluded this research by saying that placebos are a form of cognitive therapy which when incorporated into depression care along with antidepressants minimize unpleasant side effects while holistically treating depression.
This study has thus proven the ability to enhance resilience to depression with the use of placebos as a form of cognitive therapy. Further research and use of placebos is therefore encouraged to combat depression since it is degrading the quality of life for a vast portion of our population.