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The doctor-patient relationship is critical to the placebo effect.
The big bulk of the response to antidepressants is the placebo response.
Antidepressants can have troubling side effects and are addictive for some people.
One problem I have with drug companies is that they don't make all their data public.
Anything that instills a sense of hope will at least temporarily help treat depression.
If doctors just spent more time with their patients so they felt more reassured, that might help.
There seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients.
Perhaps 10 percent of patients who are prescribed antidepressants are really benefiting from the drugs' active ingredients.
Patients who trust their doctors and have a psychological expectation of getting better could trigger a reaction in their body.
Psychotherapy works, and some types of therapy have been shown to be much more effective than antidepressants over the long run.
To someone who is not currently on anti-depressants, I would suggest trying other treatments first - for example, psychotherapy.
Nocebos often cause a physical effect, but it's not a physically produced effect. What's the cause? In many cases, it's an unanswered question.
I do a lot of research on the placebo effect, not just in depression but in irritable bowel syndrome, pain, arthritis of the knee, migraine, asthma.
There seem to be many causes of depression. One cause is profound loss, grief. Economic hardship we know is linked to depression. We don't have a full picture.
Perhaps anti-depressants should be best reserved for the very extreme cases and, more importantly, for those who do not respond to alternative forms of interventions.
There are a variety of techniques to help people change the kind of thinking that leads them to become depressed. These techniques are called cognitive behavioral therapy.
Depression comes back over time in about 90 percent of people on antidepressants. Studies show that relapses are far less common when people are treated with psychotherapy.
The one thing we do know is that the chemical imbalance theory - the theory that people get depressed when they don't have enough serotonin in their brain - we know that that's wrong.
If you're taking an antidepressant, it's working, and you're not experiencing side effects, go on taking it. But if it's not working, or not working well enough, or if you have side effects you don't like, talk to your doctor about an alternative approach.
Depression is not caused by a chemical imbalance in the brain, and it is not cured by medication. Depression may not even be an illness at all. Often, it can be a normal reaction to abnormal situations. Poverty, unemployment, and the loss of loved ones can make people depressed, and these social and situational causes of depression cannot be changed by drugs.
Depression is a serious problem, but drugs are not the answer. In the long run, psychotherapy is both cheaper and more effective, even for very serious levels of depression. Physical exercise and self-help books based on CBT can also be useful, either alone or in combination with therapy. Reducing social and economic inequality would also reduce the incidence of depression.