Tran, Sibek Kevin Tran Zac Sibek Bio 100 Professor Rosales 29 April 2013 SSRIs and the

Placebo Effect Major depressive disorder, commonly known as depression, affects 14.8 million Americans, or 6.7% of the population. Symptoms of depression include low moods, helplessness, worthlessness, and negative feelings. Depression stems from a combination of biological, psychological, and social effects, prompting it to be a rather complicated illness to fully understand and treat. Because so many Americans

suffer from it, depression and medication used to treat it have become a topic of heated debate, mainly with SSRIs. (WebMD 2000) Selective serotonin reuptake inhibitors (SSRIs) are a class of pharmaceutical drugs used as antidepressants in the treatment of mainly depression. Researchers believe that the neurotransmitter serotonin plays a key role in maintaining mental stability due to its influence on key brain activities such as sexual desire, mood, appetite, sleep, memory, learning, and some social behaviors. Because serotonin is involved with so many basic brain functions, researchers also believe that among the depressed, there is a shortage of serotonin activity. SSRIs treat depression through the inhibition of serotonin reuptake back into the presynaptic cell during the chemical synapse between neurons. By blocking the presynaptic receptors that reuptake serotonin, the postsynaptic receptors will be able to absorb serotonin at a faster rate. Common forms of SSRIs include Prozac, Zoloft, and Paxil. Although these drugs have had clinical success in fighting depression, there have been countless cases of adverse side effects including nausea/vomiting, drowsiness, sexual dysfunction, changes in appetite, tremors, and suicidal ideation. Because of all these negative side effects and the mysterious nature of the illness, many researchers doubt the validity and efficacy of using SSRIs as a form of treatment for depression. One main focus of controversy regarding SSRIs is the placebo effect. (Staff. Mayo. 2010) In the world of science and medicine, the placebo effect is used in two distinct ways. It is scientifically employed in the laboratory setting through the use of placebo-controlled studies, where researchers will give a control group the placebo, the treatment specifically designed to have zero effect.

Tran, Sibek Because they have administered the placebo to control group, they can measure whatever changes were

made in the experimental group, and deduce how the treatment affected the subjects. In many cases, if both the placebo and experimental group show the same variance caused by the placebo and the actual treatment, the experiment is deemed a failure. However, speaking from a medical standpoint a placebo effect can be beneficial. On a medical level, the placebo is an ineffective or simulated treatment for a condition designed to deceive the patient. In some cases however, patients will show signs of medical improvement by just consuming the placebo as apposed to the real treatment. This placebo effect plays a key role in the study of how the brain affects the individuals physical health. In the case of SSRIs, researchers have found remarkable findings in regards to how they provide treatment to those suffering from depression. In 2008 Irving Kirsh, an associate director of the Placebo Studies program at Harvard Medical school, challenged the efficacy of SSRIs in his meta-analysis, published in the the PLoS Medicine. By comparing the results of numerous published clinical trials with the results of from unpublished trials, Kirsh found that the benefits of antidepressants (SSRIs), compared to a placebo, fall below what is actually considered clinically significant. Kirsh found that drug-placebo differences increased as a function of initial severity, rising from virtually no difference at moderate levels of initial depression to a relatively small difference for patients with very severe depression, reaching conventional criteria for clinical significance only for patients at the upper end of the severely depressed category(Irving 2008). In other words, for those who suffer from low to mild depression, SSRIs seemed to have no clinical significance compared to their placebo counterpart; SSRIs only had a powerful effect on those who suffer from extreme cases of depression. These findings ultimately imply a couple of notions, the notion that our brains have the ability to cure themselves, and the notion that other treatments could potentially be more effective and less harmful. Although these findings point to the notion that as individuals, people can heal themselves, it does not mean that antidepressants do not work, nor does it mean to stop taking them. The reality of the situation is that peoples bodies are only reacting in a positive way due to the perceived notion that the medication they are taking is having a positive effect on them. In other words, the placebo or in other cases the actual medication, is acting as a trigger for our bodies to repair themselves; In the same way a bullet does not fly

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without something to stimulate the trigger, the body does not heal without something to instigate the bodily reaction. In addition to the bodys natural ability to heal itself, psychiatrists and psychologists may be better suited to using other forms of treatment such as physical exercise to increase endorphin production, or cognitive behavioral therapy to fix maladaptive behaviors or delusions. As individuals, we are all exposed to feelings of sadness and sorrow at various points in our lives. The degree of sadness is relative to our situations and our personalities, but these feelings make us human. Because the symptoms of depression are so human and common, it is easy for our society to quickly pass judgment on ourselves, and to label each other with depression. With that in mind, knowing the implications of SSRIs amongst the depressed in conjunction with the placebo effect, society can become smarter consumers through their scientific literacy.

Works Cited

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"Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration." PLOS Medicine: Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration. PLoS Medicine, 26 Feb. 2008. Web. 29 Apr. 2013. Kirsch, P.h.D, Irving. "Antidepressants: The Emperor's New Drugs?" The Huffington Post. TheHuffingtonPost.com, 29 Jan. 2010. Web. 29 Apr. 2013. "Serotonin and Depression: 9 Questions and Answers." WebMD. WebMD, 03 Jan. 0000. Web. 29 Apr. 2013. Staff, Mayo Clinic. "Selective Serotonin Reuptake Inhibitors (SSRIs)." Mayo Clinic. Mayo Foundation for Medical Education and Research, 09 Dec. 2010. Web. 29 Apr. 2013. Szalavitz, Maia. "Antidepressants: Are They Effective or Just a Placebo." Times. N.p., 3 June 2010. Web. 28 Apr. 2013.