Caring vs Serotonin

by Richard C. Raynard, Ph.D.
Licensed Clinical Psychologist

Can the act of caring be as effective as medication in battling depression and anxiety? Research into selective serotonin reuptake inhibitors (SSRIs) may provide answers that surprise you.

SSRIs are one of the newer class of antidepressants that emerged in 1987 with Prozac (fluoxetine), an approved treatment for depression. Since then, SSRIs have proven effective in treating many anxiety-related illnesses including panic disorder (PD).


Choices



Cherry Picking SSRI Research

Turner and others in 2008 subpoenaed the FDA to release ALL of the studies on antidepressant effectiveness in their archives.  They found that reports of positive effects were 12 times more likely to be published than negative results. Overall, the impression of effectiveness was inflated by about 33%. Over the past century, only 50% of all drug studies were published, mostly positive outcomes (Dobbs, '06).

Small Advantage of SSRI's
Two large scale metanalyses of SSRI effectiveness showed that SSRI's are effective 56-60% of the time. However, between 42 and 47% respond to placebos ("sugar pills"), making the effectiveness of SSRI's only about 10 to 15% better than a placebo (Arrill, '05; Dobbs, '06).

Growing Placebo Power
Since 1985, the potency of placebos, the benchmark for measuring medication effectiveness, has nearly doubled, from about 30% to about 45%. So it is harder than ever to show the effectiveness of medications. In 2007, the FDA approved the fewest drugs of any year since 1983 (PN, '10). The advertising success of Big Pharm may have led to the public increasingly to  believe that any pill will work!

Whoops!
In a major study of depression by NIMH, comparing imipramine to a placebo, they found the most effective psychiatrist got better results with a placebo than the worst performing psychiatrist with antidepressants.  This was back door evidence for the importance of relationships of therapeutic effectiveness (McKay et al, '06).

Relationships are Central
In the big debate about which evidence-based psychotherapies will be reimbursed by insurance, a growing body of critics question the focus on method (LeBow,'10). A metanalysis by Wampol ('02) showed that success in treatment was accounted for mostly by relationship factors between therapist and client, and less by treatment methods. Good relations of caring, empathy and openness may be the most effective part of psychotherapy. Shouldn't we be studying the "placebo effect" rather than the "drug effect"?

Could this mean that love (caring) conquers all?  Well...yeah.

About Dr. Raynard
Dr. Richard Raynard is a licensed clinical psychologist with 35 years experience resolving a broad range of emotional problems. As a cognitive-behavioral therapist who has specialized in anxiety and phobic disorders since 1980, he has spent the last 35 years fulfilling his life-long desire to explore and define the true purpose of emotions and how people can easily use emotions to create meaning and satisfaction in their lives. Dr. Raynard's series of books on emotions can be found on Amazon.com. His other books include Don't Panic, and Anxiety & Panic Medications.