Don't let hype get in the way of help

There are many people suffering from depression in Ireland who are now confused, even despairing, following the release of a recent survey on the effectiveness of anti- depressants, suggesting that they are no more effective than placebo therapy.

As a GP who is experienced in this area, and having done a lot of research into how all therapies work in the brain, I would like to clarify certain issues and throw some light on what I see as weaknesses in the research conclusions.

First, it was a meta-analysis (ie, a statistical summary) of other trials, not a proper trial in itself. Second, the average length of the trials studied was six weeks. Third, it in my opinion made some extraordinary conclusions based on the evidence collected over such a short period -- in particular that drug therapy in moderate/severe depression was to all extents useless.

The truth lies in a proper understanding of the placebo effect. When we treat illness with any therapy, the expectation that help is at hand activates key pathways in the brain, which gives an initial feeling of wellbeing. This effect will, however, last for only a certain period of time, usually six to eight weeks, after which time it will start to wane, particularly if the therapy used is not effective.

In depression, where people are in real pain, this effect can be initially very powerful. But it, too, will wane after eight to 10 weeks if the therapy is not effective.

So what we actually see at the beginning of all therapies is a combination of the placebo effect and the effect of the therapy itself. After this period, the placebo effect wanes and the therapy will have to stand on its own merits.

This is why I am so critical of the conclusions reached in this report. To really assess a therapy, we need to move beyond the placebo effect to get a true picture of its effectiveness.

In researching my own book, I was influenced by the work of Professors Benedetti and Helen Mayberg, world leaders in assessing all depression therapies versus the placebo effect. They showed, for example, that drug therapy and placebo therapy activated similar parts of the brain -- but, crucially, the former acted on key areas that the latter didn't, and this was felt to be the key to their longer-term effects.

Of great interest was the information that Cognitive Behaviour Therapy (CBT) activated both placebo pathways plus distinct parts of the brain as compared to drug pathways. Interpersonal Relationship Therapy was similar. All the placebo effects were most powerful in the first six to eight weeks.

Benedetti in particular was convinced that we can really only assess the true effectiveness of a therapy when the placebo effect wanes. In practice, we could only decide on the relative merits of any therapy for depression if a major trial of thousands of people treated with drug/CBT/alternative medicines etc versus placebo therapy were carried out over a period of at least one year, preferably with scanning included.

I, along with Benedetti, feel we are too slow to dismiss the power of the placebo effect at the beginning of any therapy -- as hope is such a powerful human emotion -- but we must be realistic about the length of time it will last and therapies must be assessed over a longer period.

I have helped many people with depression and always approach it holistically. I always stress the importance of proper nutrition, exercise, supplements and avoiding alcohol as basics. Sometimes I use drug therapy and find it helps the person with real depression to feel well enough to be able to then make the lifestyle/psychological changes in their life -- the real secret to not only getting well, but staying that way.

I sometimes use CBT either at the beginning or after eight weeks of drug therapy, and on other occasions refer for counselling. The patient themselves must be involved every step of the way. It is the wise use of all these tools that has helped so many back to mental health. I would be concerned if one of the main planks of this holistic approach were to be sidelined due to a lack of real understanding of the placebo effect.

My advice to the countless numbers on treatment, disturbed as a result of this report and the media frenzy following it, is to look beyond the placebo effect of all therapies and get whatever help you need to become well again.

The main message I have for you all is: you can, with proper, sensible use of whatever therapy works for you, be healed and be well again. Do not let hysteria and statistics get in the way of getting the help you need, for you are truly worth it.

Dr Harry Barry is author of 'Flagging the Problem: A new approach to Mental Health' (Liberties Press) and director
of Aware.

Source:

www.Independent.ie