Tag Archives: anti-depressants

Alternate Reality

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Yesterday, I was talking about the placebo effect of antidepressants.  I had started to write about my reaction to the denial surrounding the use of anti-depressants and went down a different thought train than I intended.  So, today I want to get back on track and talk about a new perspective I have been contemplating surrounding anti-depressant use.

It use to be that I lived in a world where I thought there was some truth I could find and adhere to.  For instance, I believed that anti-depressants did not work.  I even had scientific research to back it up. Now, I have an understanding that the world I live in is deceptive.  For instance, I once read research that claimed liquid extracts of feverfew were ineffective in treating migraines.  So, I stopped taking my feverfew tincture and my migraines came back.  So much for scientific research.

But it is not that the research is wrong…

Buddhism, Ho’oponopono, and new age perspectives all concur that the world we see around us is created (fully or in-part) by ourselves.  This means that just because antidepressants don’t work in my world, doesn’t mean they are not effective in other people’s worlds.

This means that I’ve “created” a world were anti-depressants do not work.  I see research that supports that, all my friends that use anti-depressants do not feel better, and I disregard claims that anti-depressants work as “placebo effect.”  And since the world I create is 100% real this is a valid reality.

On the other hand, other people live in a world where anti-depressants work.  Not just placebo work, but actually work.  They get mad at people like me that say their drugs do not work because they have evidence.  They have tried diet, exercise and herbs only to have those treatments fail.  These people go to doctors that know anti-depressants work and they feel better when they take them.  They really do have a brain chemistry imbalance that is corrected with pharmaceutical.  Their world is also 100% valid reality.

My reality is valid and all the alternative realities are also valid.

I have noticed that I spend a great deal of time arguing in support of my perceptions in my head.  I justify what I do by thoughts that support the rightness of it.  I also see others telling each other what to do and what works.  “All of us know what is right.”

I can imagine a true path to non-violence includes accepting that other people’s worlds are different from ours.  Not just their perspectives and experiences, but the actual makings of the world they live in are different.  They are not just apparently different.  They are functionally different as well.

I was once at a scientific conference with some of the big names in physics there.  One of the discussions centered on the problem of being able to replicate research.  For instance, someone (perhaps hypothetical) had developed a process of doing fission to create unlimited energy, but no one else could reproduce the process.  The creator had what it took to manifest this incredible creation, but others didn’t.  His world included fission, while for the rest of us it does not exist (yet).

The crux of the problem was what I just described.  Each person creates their world and if they do not have the karma or beliefs that include certain realities or if they have the beliefs that excludes certain realities then they will not experience them. As far as I know we have the technology to cure all disease, to feed all people, to clean up all pollution.  What stands between us and the Garden of Eden is simply misbeliefs held by the majority.  (That is why I like ThetaHealing so much.  It is a way to remove dysfunctional misbeliefs.)

 

Placebo

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I’ve been so busy with work and school, it is so good to finally have some time to write.

This week we studied co-occurring disorders.  I was especially interested in the perspective presented on depression.  Mainstream medicine appears to be in denial around the use of anti-depressants.  Research consistently shows that antidepressants do not work any better than placebo.  So why do we still use them?  They get approved as drugs because they do have a statistically significant effect on depression.  However, that effect is not clinically significant.

The difference between clinical significance and statistical significance can be described like this:  Le’ts say that people start the study with depression reported as a 7.0 on a ten point scale with the most severe depression being 10.  And at the end of the study they have improved to a 4.0.  That’s great!  They are feeling better.  However, the placebo controls have also improved and they come in at a 4.1.  For our example the 4.0 is statistically different than the 4.1.  However the difference between placebo and anti-depressant is not clinically different.  People just don’t say, “my depression is down to 4.0 from 4.1 and I feel the difference.”

Different ailments appear to have respond differently to placebo.  Depression is highly responsive to placebo.  Research from 1999 found the effects of placebo on depression to be 75%.  However, these placebo effects on depression have been continuing to grow over the past couple decades, so that now we are finding certain antidepressants no better than placebo.  Menopausal hot flashes also have a nice placebo response.  And at least one third of the results of pain relief can be attributed to placebo effect alone.

Placebo, or context effect as I like to call it, has been extensively studied.  We know some of the things that will increase the likelihood of a treatment being effective.  These range from the color of the pill to patients perception’s of the health care practitioner.   Placebo effect is really not much different than marketing.

The mental health practitioner doesn’t realize that when they listen attentively to their client, label them with a disorder name (e.g. “You have bipolar depression.”) and tell the client that there is a pill that will “stabilize their brain chemistry” they are actually marketing the treatment.  They may also tell the client that the drug’s effects could “kick in” immediately, or they might occur slowly over a period of a couple months.  This gives the client options on how to respond to their “placebo/antidepressant”.  If the client then runs into someone that is on “their” antidepressant and they say it “saved their life”, they have additional context to boost the effectiveness of the treatment.

The word “placebo” has gotten a bad wrap, in the sense that only a fool would respond to placebo effect.  That is one of the reasons I prefer “context effects” over “placebo”.  Context matters and optimizing context to support healing seems like a good strategy, not a unethical strategy.  Certain settings, particular colors, and personal biases make a difference in treatment effectiveness.  Does optimizing context fall under the adage of “first do no harm” or does it harm someone to play into their natural tendencies to put faith in certain people, places and things?

REFERENCES
Kirsch, I., (2008). Challenging Received Wisdom: Antidepressants and the Placebo Effect.  McGill Journal of Medicine, 11(2): 219-222.

Di Blasi, Z. & Kleijnen, J., (2003).  CONTEXT EFFECTS:  Powerful Therapies or Methodological Bias?  Evaluation & The Health Professions, 26(2), 166-179 DOI: 10.1177/0163278703252254.