Powerful Proof: Prozac’s Just a Dangerous Placebo
An innovative study has now shown that Prozac is just as good or bad as the placebo effect. . . .
Placebos and nocebos. The placebo effect is the well-known benefit conferred by the belief that an intervention is going to work; the nocebo effect is the less know negative effect caused by the belief that the intervention is not going to work. Prozac, it turns out, is as good as the placebo effect and as bad as the nocebo effect.
This intriguing study looked at two previous studies of Prozac. There were two parts to the analysis. The first included 673 people with major depressive disorder who responded to 12 weeks of Prozac. The important detail, though, is that the study was not blinded: they knew they were on Prozac.
At the end of the successful 12 weeks, all 673 people were told that they would now either continue on their Prozac or be switched to a placebo for another year. This time, the study was blinded. No one knew if they were getting the Prozac or the placebo, so doubt—the nocebo effect—was introduced: confidence in their treatment was shaken.
After doubt was introduced by the possibility that they were only on a placebo, depression—as measured by the Hamilton Depression Scale (HAMD)—significantly worsened in both groups: those on the placebo and those on the Prozac. And the worsening depression was essentially equal in both groups (.46 for Prozac and .48 for placebo for a significance of P<.001 in each).
This study shows two things. The people on Prozac only got better as long as they knew they were on Prozac. That is, the benefit is attributable to a placebo effect. As soon as they thought they even might be on a placebo, the benefit disappeared: the nocebo effect. The researchers say that the worsening of the depression after the introduction of a possible placebo was significantly associated with the degree of improvement when they knew they were getting Prozac. That means they got as much worse when they thought they might not be getting Prozac as they got better when they knew they were.
The authors conclude that changes in expectations affect changes in depression. Which is a delicate way of saying that Prozac is just a placebo with dangerous side effects.
J Clin Psychiatry 2014;75(10):1040-6
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