Fake drugs have been shown to be at least as effective as antidepressants at treating mental illness, so why does your prescription still say ‘Prozac’?
Katie Peabody held the glistening, impossibly airy Entenmann’s chocolate donut up to her mouth knowing one of two things were about to happen: Either she’d finish it and go about her day like nothing ever happened, or the chocolate in its sticky, mud-brown frosting would make her go blind.
A doctor had warned her about the possibility of this side effect early on. It was 1988, and she was a research subject in his Columbia University clinical trial for an exciting new antidepressant he’d touted as the “next Prozac” (though she doesn’t now remember the name of the exact drug). Severely depressed, socially isolated and living a life she describes as “completely devoid of pleasure,” she’d jumped at the opportunity to enroll — she desperately wanted to change herself, and a new pill seemed like a promising solution.
There was just one problem. As the doctor had explained, there was a 50 percent chance she’d be taking a placebo, an inert substance with no physiological effect. And because the trial was double-blind, she’d have to wait until afterward to find out whether the vial of pills he’d given her was filled with active drugs or total fakes. Just to be safe, he advised her to stay far, far away from chocolate — he didn’t want her to go blind in case she was taking the real thing.
In her mind, too, there was no doubt — of course, she was taking the real thing. Within a few hours of popping one of the little white pills, almost every symptom of her debilitating depression had lifted as it were no heavier than a bedsheet. “Almost instantaneously, I felt like a totally different person,” she says. “Every aspect of my life changed.” Not only did she become more social and present than she’d been in years, she also started to enjoy the things she’d lost interest in. She even rode the roller coaster at Coney Island with her boyfriend, something she’d never have done before.
Still, something inside her ached to know who was truly in the driver’s seat — was her life turning around because of her, or because of a drug?
Good thing there was a certain chocolate-flavored litmus test she could use. She sank her teeth into the donut and awaited her fate. Within a few minutes, her vision faded entirely to black. Once everything had gone dark, her boyfriend helped her into bed, where she sobbed uncontrollably as she envisioned how her life was about to change. But when she woke up two hours later, her vision had returned. She was shook up, but a part of her felt satisfied knowing she was taking the real drug. She was actually getting the help she needed, after all.
A few weeks later, Peabody returned to Columbia for her final appointment with the test’s administrator. When their session was over, he asked her if she wanted to know whether she’d been taking a placebo or the real drug. To her utter surprise, she’d been taking the placebo the entire time. Her improved mood, social life and relationships hadn’t been the result of some newfangled pharmaceutical — they’d been caused entirely by her.
“I was totally wowed,” Peabody, who is now 66 and a creative director, copywriter and storyteller, tells me. “On one hand, I felt disappointed, like I’d been conned. But on the other, I realized I’d done all this for myself. I was suddenly overwhelmed, and even a little scared by how powerful my mind could be.” After that, something shifted in her for good — she still had bad days every now and then, but she never felt “plagued” by depression again.
According to Luana Colloca, a placebo expert at the University of Maryland, reactions like Peabody’s aren’t uncommon in depressed patients who are randomly assigned placebos in clinical drug trials — though they’re taking a fake drug, their depression will often improve and their good mood will last. In fact, according to a 2008 meta-analysis published in the journal PLoS Med, placebos have been shown to be at least as effective as antidepressants (if not more so) in treating cases of mild to moderate depression. They can help with major depression like Peabody’s, too; while real drugs are often more effective in these cases, research from University of Utah psychiatrist Jon-Kar Zubieta found that placebo was a productive treatment for 45 to 50 percent of severely depressed participants. They’ve even been shown to significantly improve symptoms of Parkinson’s disease, irritable bowel syndrome, allergies and a laundry list of other conditions…