Placebo nation

May 18, 2002

IN PILLS we trust. The latest mood-altering prescription medicines. Sugar pills. No matter.

Such is the latest word from the final frontier, the vast unknown of the space between our ears. Like the far reaches of outer space, here is where we confront the most profound questions. Who are we? What afflicts us? How to heal it?

Not that long ago, people with serious mental problems were locked up or exiled to the wilds. Depressive malaises were attributed to failures of will or morality. Then a certain Viennese doctor, himself prone to altering his state of mind with cocaine, launched us down the long and winding road of talk therapy.

And then came the latest generation of antidepressants, mood-elevating psychotropics so well refined and marketed over the past 15 years that they have become embedded in our cultural woodwork. Aggressive salesmanship has produced a remarkable degree of social acceptability for these drugs, not to mention more than $12 billion in revenue from the U.S. market last year.

What a natural fit for the baby boom generation, which came of age along with a cafeteria of recreational drugs. What a perfect fit for the world of managed health care, pills being a whole lot cheaper than therapists. What a tailored fit for our age of ever more instant gratification.

Make no mistake, major depression is a terrible disease that affects tens of millions of Americans, who annually gobble up more than 10 million prescriptions a year for various antidepressants -- a tally that's been growing by leaps and bounds. This category of drugs now accounts for more than 8 percent of all prescription revenue, the single biggest source.

No doubt, these drugs -- Prozac, Zoloft and the like -- have helped many, though far from everyone who has taken them, including some who have had negative reactions. And of course, it has long been noted that their pervasive use can be likened to the role of soma, the stay happy, productive and unquestioning drug in Brave New World, Aldous Huxley's frightful vision of the future.

Now a new study published in The American Journal of Psychiatry shows that sugar pills work about the same -- or even better -- than antidepressants in terms of patients' reports of improved moods.

Significantly, that study also found that the placebos tended to produce some of the same changes as antidepressants in the prefrontal cortex, the region of the brain believed to play a big role in controlling moods. This sort of placebo effect is not new, but some researchers are finding that, in studies of antidepressants, it has grown stronger over the last two decades.

It's as if we're prone to believe that pills -- any pills -- will help us, and that belief produces relief.

There are a lot of fine points here. Real pills and sugar pills may work in different ways, researchers say. In the new study in which placebos did as well, if not better, than antidepressants, all patients got hours of attention from medical professionals; by contrast, the vast majority of people taking antidepressants see primary-care physicians for relatively short visits involving little talk therapy.

Some researchers now believe that points us back virtually full circle -- to the value of talking out our problems, our depressions. Hello again, Dr. Freud. But don't look for the use of antidepressants to do anything but become more widespread. In other words, we're still listening to Prozac but we still don't have much of a clue about what it's saying.

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