Abstract While some can see the use of placebos as unethical and pointless, much research has been conducted to prove otherwise. Research teams have discovered the positive effects that placebos can have in treating people with depression. Results have concluded that suicide rates and reduction in symptoms of depression are much the same for patients treated with either placebos or active drugs. These similarities have caused some researchers to believe that placebos can bring about bias in research results. However, some believe that these similarities should be viewed positively as they prove that placebos can reduce the negative effects associated with patients with depression. However, some researchers believe that placebos are not effective in the treatment of depression and they should not be used as a sole substitute for antidepressants.

Researchers should continue their experiments to determine the effects of placebos on depressed patients, as long as they treat the situation in an ethical manner with full consent from the patients being studied. Historically, placebos were used to humor rather than cure patients but are now more importantly used as a way of measuring the effectiveness of active drugs. A placebo is an inactive substance with no medicinal properties usually in the form of a pill. It is used in comparison with a control group in an experiment, to determine whether its effects are positive or negative. The properties of a placebo can cause patients to improve because of their belief in the efficiency of the placebo. A placebo effect is a positive response to a substance, device or procedure that occurs when the placebo has the same or similar effects as the experimental substance or procedure.

Depression is a major area of psychology where placebos are used to determine their effects. Psychologists examine groups of patients suffering from depression and use a control group, consisting of patients treated with active antidepressant drugs, to determine the effects, compared to those of other patients treated with a placebo such as a sugar pill. Some scientists argue the ethical side of using placebos, but many are interested in the effects resulting from their use. Studies show positive results from using placebos, and many scientists argue the fact that placebos should be used if they are effective and prescribed ethically with full consent from the patient. Some scientists also argue that placebo-treated patients are being untreated as they are being treated with a "dummy" drug, but other than the prescribed drug, they are treated in exactly the same way as the control group. Placebos can cause bias in research results, as the effects of placebo-prescribed patients do not differ greatly from patients prescribed with antidepressants in terms of suicide rates and symptoms of depression.

This can lead to researchers believing that placebos are as effective as general antidepressants when treating depression. Antidepressants have proved successful in the treatment of depression, however the introduction of placebos has shed a new light on alternative treatments. Many studies have been carried out by researchers to compare the effects of placebos versus antidepressants. One such study, performed by "The Cochrane Collaboration Depression, Anxiety and Neurosis group" concluded that although antidepressants were effective in treating depression, placebos were also thought to be substantial. Their objective was to investigate the effectiveness of antidepressants when compared with placebos. Randomised groups of patients suffering depression were treated with antidepressants and formed the control group of the experiment.

This control group was used to compare the effects of the antidepressant with the placebo, with patients suffering from depression. Nine studies, involving 751 participants resulted in the active drug being favourable in treating depression, however it concluded that the differences in the effectiveness between antidepressants and placebos was relatively small. (Moncrieff. J, Wessely. S, Hardy. R 2003) Placebos are often perceived as less desirable in terms of its ethical values.

They are generally identified as non-treatments, inferior to the active drugs. The accuracy of diagnosis and authenticity of illness is often questioned when placebos are used and it is often looked at that patients are being "tricked" into thinking they are undertaking an active drug. However, psychiatrist Arif Khan, of the Northwest clinical research centre in Bellevue Wash, argues this ethical issue. He quotes, "Patients who are assigned to placebo treatment in clinical trials are not untreated. The capsule they receive is pharmacologic ally inert, but hardly inert with respect to its symbolic value and its power as a conditioned stimulus" (Bower 2000). Helen Mayberg, a researcher at the Research Institute at the University of Toronto, agrees with Khan and states "Treatment with a placebo is not absence of treatment, just absence of active medication" (2002).

Khan, like many other researchers, argued that placebo patients were treated in exactly the same way as the active-drug patients in terms of them receiving the same physical examinations, attention and guidance from their physician, opportunities to talk about their condition and general assistance in their treatment (Bower. B 2000). After thousands of studies, hundreds of millions of prescriptions and tens of billions of dollars in sales, two things are certain about pills that treat depression: Antidepressants like Prozac, Paxil and Zoloft work. And so do sugar pills.

(Vedantam. S, 2002) Researchers (un-named) found that in the majority of clinical trials conducted in recent decades, sugar pills have done as well as, if not better than antidepressants. One study shows that even after pre-screening, about a third of all depressive patients studied, responded just as well on placebo as those on the active drug. The theory they created on these grounds is that the placebo is a much superior treatment for those patients, which responded positively on grounds of both safety and cost. Henry K. Beecher, a researcher, published a study called "The Powerful Placebo" in which he reviewed 15 clinical trials to determine whether placebos had a positive or negative effect in the treatment of depression.

From his results, Beecher claimed that on average, about one in three patients found relief from placebos alone. He found that anywhere from 10 to 100% of patients taking placebos in trials saw their symptoms diminish, which perceives the placebo as being a beneficial drug (1995). Khan and his research team studied the rates of suicide and attempts as effects of the administration of active drugs and placebos. He found that the rates of suicide and attempts were nearly the same for patients treated with placebo as those treated with active drugs. Many researchers do not agree with Khan, Beecher and their results. The researchers at UCLA found that while a mere 38% of patients treated with placebo improved, more than 50% of the patients treated with active drugs improved (Leuchter.

AF, Cook. IA, Wittle. EA, Morgan. M, Abrams. M 2002). Many of their placebo-treated patients developed major side effects and eventually had to be treated with medication.

Dr As bjorn Hrobjartsson published a study in The New England Journal of Medicine and his findings agree with those of UCLA in that he reported "Placebos were no more effective than doing nothing." (web N. D. ) Some researchers believe that placebos can cause bias in research results, as studies have concluded that there is little difference in the effects of placebo-treated patients and active-drug treated patients. However, these similarities should be positively looked upon, as these studies prove that placebos can have a positive effect in the treatment of depression.

As long as patients are treated in an ethical manner and are completely aware of the placebo and its effects, more research should be conducted to prove the positive effects that placebos can have in the treatment of depression. References: Bower. B, 2000 Vol. 157, No 18 Placebos for depression attract scrutiny web > Henderson. CE 2001 Placebo Effects Prove the Value of Suggestion web > Leuchter. AF, Cook.

IA, Wittle. EA, Morgan. M, Abrams. M 2002 Changes in brain function of depressed subjects during treatment with placebo American Journal of Psychiatry, 159 (1): 122 -129 web > Lewis.

L 2001 Use of Placebo in Clinical Trials For Mood Disorders: A Consumer Perspective web > Mayberg. H 2002 Placebo, Antidepressant May Lift Depression Via Common Mechanism web > Medawar. C 1997 International Journal of Risk and Safety in Medicine Blindness and placebo response in antidepressant drug trials web > Moncrieff. J, Wessely.

S, Hardy. R 2003 The Cochrane Library, Issue 2. Active placebos versus antidepressants for depression web > Vedantam. S 2002 Against Depression, a Sugar Pill is Hard to Beat Beecher. HK 1995 The Powerful Placebo web > Definition Wolman, Dictionary of Behavioural Science.