A pill, drug or other physical form of medicine is often assumed
to be the only effective component, but could be just one of
several parts of a successful treatment for depression.
A recent study conducted at the UCLA Semel Institute for
Neuroscience and Human Behavior shows that an activity decrease in
the front part of the brain when a patient receives a placebo
suggests a better response to subsequent antidepressant
treatment.
The results of the study indicate that factors other than
medication, such as doctor-patient relationships, treatment
expectations and the physical act of taking a pill, complete the
picture for successful treatment of depression, said principal
investigator Aimee Hunter, a research psychologist at the
Institute.
“Most clinicians already understand treating the whole
patient is important, but this is just a factual example,”
Hunter said. “It provides stronger grounding for depression
treatment.”
The nine-week study period consisted of 51 adult subjects with
depression receiving one week of placebo followed by eight weeks of
antidepressant medication.
The cordance, or measurements of electrical activity, was
recorded before and after subjects were given the placebo.
Those with a decrease in the area of the brain at the top of the
forehead during placebo lead-in tend to do better after eight weeks
of medication, Hunter said.
“The larger the decrease, the better they did,” she
said.
The fact that the subjects had already experienced a change in
brain activity even without the medication suggests that they had
already responded to changes in conditions from counseling or even
the mere idea of treatment.
“People often respond to the infusion of hope, from
struggling on your own without support,” said Elizabeth
Gong-Guy, the director of UCLA Student Psychological Services.
In addition to the change in hope, the patient’s attitude
toward and expectations from treatment are crucial factors, said
Michelle Abrams, the research nurse who checked up on the patients
each week.
“If they come in with the expectation that the pill and
program will work, they tend to respond better to the
placebo,” Abrams said.
Other patients responded to factors such as the simple action of
taking a pill.
“The pill is tangible and it felt like I was doing
something definite about my condition,” said Charles Park, a
32-year-old placebo subject in the study. “Just the fact that
I was taking something and that there was an anticipated effect was
helpful.”
Studies are currently being conducted to assess how important
each factor is, as well as to find more refined ways of pinpointing
areas of brain activity, Hunter said.
While some may respond well to such factors, others respond only
to antidepressant medication. There is no definite treatment method
that will work for all people, Gong-Guy said.
“The big question in psychiatry is the mystery surrounding
why a certain patient gets better after medication and others
don’t,” Hunter said. “This study indicates that
the placebo is a major contributor to predicting how someone will
do.”