What does the latest research on the placebo effect mean for the one million children in the United States, some as young as six, who are diagnosed with "childhood depression" and taking antidepressant medications?
The CBS News show 60 Minutes brought this issue into the limelight this past Sunday (February 19, 2012), with Leslie Stahl's interview of Dr. Irving Kirsch. At present, the pharmaceutical industry brings in 11.3 billion dollars a year selling antidepressants. Kirsch, who is the associate director of the new Placebo Studies Program at Harvard Medical School, is "throwing a bomb" (Stahl's words) into the profits of pharmaceutical companies by his challenges to the effectiveness of their antidepressants.
Kirsch's research shows that the difference between taking antidepressants and ordinary sugar pills is "statistically insignificant." It is not the chemicals in the drugs that work, he says, but the creation of an "expectation" in the patient that the pills ill make the patient feel better.
Kirsch's first research studies on the placebo effect were so surprising, that he did a second round of research. He retrieved clinical studies by drug companies from the FDA. These studies had never been published because they showed no clinical benefit from the antidepressants. Drug companies can conceal the results of unsuccessful clinical trials. They only published the studies showing the positive effects of their antidepressants. The drug industry also suppressed clinical trials that showed severe side effects of antidpressants.
Kirsch compiled all the clinical trials, both the successful published studies and the unsuccessful ones that remained hidden. He concluded that there was no clinically meaningful difference between the drugs and the placebos for mild and moderate levels of depression. For severe depression, the drugs were more effective.
Kirsch is not saying that antidepressants don't work, because obviously they do. What he is saying is that the mechanism by which they work is not by a chemical effect but the placebo effect.
Dr. Walter Brown of Brown Medical School also appeared on the 60 Minutes segment. He said that he and many of his colleagues in the field of psychiatry are challenging the theory that depression is caused by low levels of the chemical seratonin in the brain. "Experts in the field believe that theory is a gross oversimplification and probably is not correct." Since antidepessants are thought to target seratonin, this idea threatens to bring down the whole house of cards on which antidepressant research is based.
From my work with children, I know that children are especially open to the power of expectation. If the important adults in a child's life, like parents and doctors, expect a pill to make the child feel better, an almost hypnotic suggestion of healing is planted in the child. Placebos thus could have an exceptionally powerful effect on children.
The most serious problem about giving children antidepressant medications is that many of the drugs have serious side effects which have been hidden by drug companies. I document some of the studies showing side effects in my book Suffer the Children.
Many parents have been helped by antidepressant medications, and when their child seems depressed, they naturally want to help their child in whatever ways they can. Many parents, however, don't realize that antidepressant mendications are prescribed "off label" for children. That is, the FDA has not approved their use for children because they have not been tested for use in children.
There are many alternatives to antidepressants for children. Regular physical exercise, pleasurable one-on-one outings with a parent, reading books of jokes and riddles with the child, and parents' keeping an upbeat mood in the house all can affect a child's mood. A child therapist or family therapist can also make suggestions that will help a sad child feel better. Of course if a child is already taking antidepressant medication, a psychiatrist or pediatrician should oversee any changes in doses.
Copyright Marilyn Wedge, Ph.D.
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