I am going to discuss the use of antidepressant drugs and electroconvulsive therapy and their use in the treatment of depression. Both are broadly used in the UK and elsewhere in the world and are often used in psychiatric hospitals without the consent of the patient. The biological explanation is that depression is caused by insufficient levels of serotonin and noradrenaline. Antidepressant drugs are used for the treatment of moderate to sever depression and are usually taken for at least four months, usually longer. The two main types are tricylics and Selective Serotonin Re-Uptake Inhibitors (SSRIs).
Tricylic drugs prolong the mood-lifting effects of noradrenaline and serotonin by preventing the re-absorption after they are released. It also means that the remittance of the neurotransmitters is easier and faster the next time. Similarly, SSRIs such as fluoxetine (Prozac) block the re-absorption of serotonin but not noradrenaline, prolonging the feeling of excitement and lowering depression. In 2008, Kirsch found that in moderately depressed patients, there was improvement in their conditions when using placebos as well as when using the real SSRI.
(S)he also found that in severely depressed patients there was significant advantages to using the real drug when compared with the control placebo group. The study concluded that for moderately depressed patients, it was the hope of recovery which caused their improvement whereas in severe cases, the biological effects were what caused the improvement. This suggests that, in severe cases rather than mild ones, SSRIs are more effective than placebos. Similarly, Furukawa et al, in a meta-analysis of thirty-five studies found that antidepressants were more effective than placebos.
There have been studies which have shown a rise in suicidal thoughts and tendencies in children aged six to eighteen who are taking antidepressant drugs. Olfson et al concluded this after carrying out a study in 2006 when he found that the incidence rate of adolescent and childhood suicide was significantly increased during drug-based treatment. David et al carried out research using mice (whose brain chemistry is considered closest to that of a human) and found that the changes in the hippocampus which were caused by depression were reversed when using SSRIs.
The study also found a deficient gene which displayed a reduced response when using drugs such as Prozac. The study by David et al supported the theory that there is a biological reason for why some people respond better to biological treatments than others however, since the study was carried out on rodents then, no matter how close their brain chemistry is supposed to be, the study was still done on non-human animals which means that the findings cannot be extrapolated to humans and therefore hold little external validity.
Although the best way to test the effectiveness of antidepressants on humans is to carry out a placebo study, there are several problems with this type of study. Firstly, in a blind study (where the participant does not know whether they have the real drug or a placebo) there is a possibility of experimenter bias for instance, a patient who is considered more likely to respond to a biological treatment may be given the drug while someone whom the experimenter considers unlikely to respond is given the placebo in order to result in a more favourable outcome which supports drug treatment.
One way to reduce this is to carry out a double blind study (where neither patient nor doctor knows what is being given to the patient). However, double blind studies such as Geller et al have consistently shown little difference in the effectiveness of placebos vs. drugs. However, the most prominent issue with placebo trials is that of ethics. Many studies are done without the consent of the patient and so they are not aware that they even might have a placebo which means that informed consent can never be given1.
Also, if a placebo is given to patient at high risk of suicide and who clearly needs help and they do not respond to the placebo, it could result in a worsening of their condition or even their suicide. Furthermore, if a patient is told that they are being prescribed the drug but in reality it is a placebo, they are being deceived by the experimenter and may become worse because they feel helpless when the ‘drug’ does not work. When taking drugs to combat symptoms, there are often side effects such as increased suicidal thoughts, headaches and many others which can range from mild to severe.
Drug treatment is often favoured by doctors and hospitals because it is relatively cheap and requires little supervision (unless in a psychiatric hospital) and requires very little effort on the patient’s part and many drugs do not cause any severe adverse effects when taken many at a time (overdosing). On the other hand, the lack of supervision can lead to inappropriate amounts of the drug being taken which and prolonged use of the drug can lead to both a psychological and biological dependency upon it.