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Scientists Finger Placebo Effect in Some Depression Relapse
> 9/6/2007 8:40:44 AM

It is not uncommon for patients taking an antidepressant to experience a relapse of symptoms anywhere from six months to a year after first beginning the medication. In a new study, researchers at Rhode Island Hospital conclude that these relapses are not caused by tachyphylaxis, a decrease in the drug�s effectiveness, which is also known as the �poop-out� effect. Rather, they assert that relapses commonly occur in patients who had been experiencing the placebo effect and had never actually responded to their medication. When the placebo effect, which is typically brief, wore off, their symptoms returned. Previous studies have found that 50-60% of depressed patients respond to medication, while 25-35% respond to placebos.

Depression is generally broken down into three phases. During the initial or acute stage, treatment is administered to reduce symptoms. The continuation phase, which begins six months to a year after the start of treatment, and the maintenance phase, which begins after a period of consistent improvement, are concerned with managing symptoms and preventing relapses. Of those who benefit from treatment during the acute stage, many will relapse during the continuation and maintenance stages.

Dr. Mark Zimmerman and Dr. Tavi Thongy conducted a meta-analysis on four studies of the effects of antidepressants during the continuation phase of depression. Using two different methods to evaluate relapse, the researchers determined that most relapses occurred in patients who did not respond to antidepressants but had improved because of their belief that medication would help them. The relapse rate was 7.4% in those who responded to the antidepressant and 24.1% in those who responded to the placebo.

Medication continues to be an important aspect of depression treatment, and this study shows that in most cases a patient who genuinely responds to an antidepressant during the acute stage will still find it effective during the later stages. This study also shows, however, that the mind can provide a powerful boost when it comes to treatment. A patient who truly believes that medication will help may experience an improvement in symptoms even if they do not respond to the medication. This provides hope that with appropriate treatment and a positive outlook, patients can overcome depression.

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