Dear Therapist:

My 30-year-old daughter had suffered from anxiety for a long time. After a course of psychotherapy was not successful, she began seeing a psychiatrist and started taking an anti-depressant (which is also supposed to help for anxiety). This was very life enhancing for her and she has really thrived since then. Recently she says that new research has shown that antidepressants really don’t work, and it is all a “placebo” effect. We have tried to reason with her that this has clearly been helpful for her, but she says she is strongly considering stopping the medication. I was hoping you could clarify what this new research is and if it is reliable and give us a sense of how we can guide our daughter. Thank you.  

Response:

Medication is not my forte, so I can only respond briefly and generally.

The placebo effect has often been misunderstood by laypeople and professionals alike. Anyone who tells you that they fully understand the placebo effect is lying either to you or to themselves. Full comprehension of the placebo effect would necessitate a complete understanding of the effect of psychiatric medication. This, in turn, cannot be fully understood because it would require a much greater grasp of the human mind than may ever be possible.

Just as no one can tell you for certain how psychiatric medications work, they cannot definitively state that positive results are due to the placebo effect. Additionally, even if the placebo effect is a major factor in medication efficacy, we don’t understand the placebo effect. Recent studies have indicated, for instance, that physical changes occur due to the placebo effect. For example, there has been documentation of an increase in the body's production of endorphins when treated with an actual placebo (fake medication).

Even if your daughter was being treated with a placebo, there is evidence that this can have real results. One of the likely reasons for the efficacy of placebo use is the subject’s belief in the results. This does not mean, however, that the results are “fake.” Rather, it is part of the mystery of the placebo effect, psychiatric medication, and the very human mind.

From a pragmatic perspective, your daughter’s medication is working; she is less anxious. What will happen when she stops the medication? If she will become more anxious again, why should she care about the reason behind the medication’s affect? However, if she is adamant about discontinuing medication, there are a few things to consider. Always be sure to follow a psychiatrist’s instructions. Also, the psychiatrist may be willing to prescribe an actual placebo. There is reason to believe that placebos can be effective even when given openly and without deception on the part of the prescriber. (This in itself belies the traditional understanding of the placebo effect being due to the patient getting duped into believing in its efficacy.)

I would ask your daughter what she hopes to gain from discontinuing medication, as well as what she may stand to lose. All possibilities should be considered, and she should discuss her thoughts and concerns with her psychiatrist, whose expertise can help her to make the appropriate determination.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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