Brain Scan Study Shows How Placebo Aids Depression

[Guest guest]

Hello Everyone!

I saw this article on news. I know before people talked about

the Placebo but I found this interesting.

Galli

New Haven, CT

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Brain Scan Study Shows How Placebo Aids Depression

By Maggie Fox, Health and Science Correspondent

( News - 01/02/2002)

WASHINGTON (Reuters) - Brain scans show that patients with depression

have clear physical responses to both drugs and sugar pills, but the

responses are dramatically different, researchers reported in a study

that could help explain the ''placebo effect.''

The study might show ways for doctors to use the placebo response --

when patients get better from a sham treatment or drug -- to improve

standard treatments, said Dr. Leuchter, the psychiatrist at

the University of California Los Angeles who led the study.

``People have known for years that if you give placebos to patients

with depression or other illnesses, many of them will get better,''

he said in a statement on Tuesday.

``What this study shows, for the first time, is that people who get

better on placebo have a change in brain function, just as surely as

people who get better on medication.''

The study also suggests that treating depression has two important

parts -- the medications, and the very act of seeking treatment,

Leuchter said.

``What our study suggests is that medications are effective in

relieving symptoms and placebo can be effective for some patients in

acute relief of symptoms but that they are working through different

and perhaps complementary mechanisms,'' Leuchter said in a telephone

interview.

``The placebo effect is something that is very physically distinct.''

Leuchter and colleagues set out to find out what is going on in a

patient's brain when given a placebo.

They gave 51 patients either an antidepressant or a placebo, and used

a method called quantitative electroencephalography (QEEG) imaging to

see what was happening in the brain.

DISTINCT CHANCES IN PREFRONTAL CORTEX

They saw distinct changes in the brain's prefrontal cortex. ''It's a

region associated with regulation of mood,'' Leuchter said. ``Whether

one is manic or depressed, this area of the brain commonly reflects

mood state.'' The antidepressants they used were Eli Lilly and Co.'s

Prozac, known generically as fluoxetine, and Wyeth-Ayerst's Effexor,

known generically as venlafaxine. Both work by boosting the level of

the mood-enhancing chemical messenger serotonin in the brain.

``Overall, 52 percent of the subjects -- 13 out of 25 -- receiving

antidepressant medication responded to treatment, while 38 percent --

10 out of 26 -- of those receiving placebos responded,'' Leuchter's

team wrote in the Jan. 1 issue of the American Journal of Psychiatry.

Both groups felt better.

``The immediate outcome was they were virtually indistinguishable,''

Leuchter

said.

``At eight weeks ... you couldn't tell them apart in terms of mood

ratings. What happened at eight weeks plus a day is a bit different.

Some of the placebo responders, when told they were on a placebo, had

a deterioration of their mood. In fact, most of them did. Within a

month, most of the placebo responders had enough depressive symptoms

that they actually ended up on medications.''

In other words, once people realized they were not taking real drugs,

the placebo effect stopped.

The QEEG scans, interpreted through a computer, showed something even

more interesting. ``Brain function changed at different rates,''

Leuchter said.

``The medications' effect was virtually immediate. Within 48 hours,

we saw there was suppression of prefrontal activity in medication

responders. It was an immediate and dramatic effect of medication.''

But it took two weeks for any changes to be seen in the brains of

people who responded to placebo, and when the change did come, it was

an increase of activity in that part of the brain, not the decrease

seen with the drugs.

DIFFERENT PATHWAYS TO GETTING BETTER

``These findings show us that there are different pathways to

improvement for people suffering from depression,'' Leuchter said.

``Medications are effective, but there may be other ways to help

people get better. If we can identify what some of the mechanisms are

that help people get better with placebo, we may be able to make

treatments more effective.''

Leuchter said that in depression, deciding to get treatment --

whether a drug, an herb such as St. s Wort, or other treatments

on the market -- may be half the battle.

``First of all, they made a decision to come in for treatment,'' he

said. ``They were prepared to get well. They came in, they actually

got engaged with somebody. They started talking with staff, with

nurses, with the physician. They got a lot of extra attention.''

Last month, a study in the Journal of the American Medical

Association (news - web sites) found that the three leading

antidepressant drugs -- Prozac, Zoloft and Paxil -- work equally

well.