Wouldn?t you know it?they say the good die young, but it turns out the happy may too. Scientists have discovered that mildly depressed older women tend to live longer than those who are not depressed at all.
This is contrary to most other studies on the link between depression and mortality, which have shown that depression increases the likelihood of death within a certain time period. ?This is totally counterintuitive to what you expect to see,? says Dan G. Blazer, a Duke University professor of psychiatry and behavioral science. ?We know that depression in younger populations is very clearly associated with mortality. It?s not so clear in older populations.?
The Duke study is the first known examination of mild depression and death. Other studies looked only at people with severe depression. The results might support the theory that mild depression is a survival mechanism.
The Duke study was based on a group that started with 2,401 women and 1,269 men, all older than 65. They were interviewed about their health at roughly three-year intervals from 1986 to 1997 and were separated into three categories ? depressed, mildly depressed and not depressed ? based on their answers to a 20-question test. Blazer says 10.5 per cent of the women were considered mildly depressed. The women with mild depression were, on average, 60 percent less likely than other women to die during any three-year period. Researchers took into account age, chronic illness and other factors in calculating the mortality rate. They found that depression had no influence on the mortality of men.
?We don?t want to make too much out of this except that it?s a very interesting finding,? Blazer says. The study may support a theory by University of Michigan psychiatrist Randolph M. Nesse who says that mild depression may allow people to cope more easily with their problems and remove themselves from dangerous or harmful situations.According to Nesse, humans may need ?low mood? or mild depression to deal with failure and disappointment. He says, ?People who don?t have it waste their whole lives trying to do things they won?t ever do.?
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After thousands of studies, hundreds of millions of prescriptions and tens of billions of dollars in sales, two things are certain about pills that treat depression: Antidepressants like Prozac, Paxil and Zoloft work.
The trouble is, placebos work too. A new analysis has found that in the majority of trials conducted by drug companies, sugar pills have done as well as — or better than — antidepressants. They cause profound changes in the same areas of the brain affected by the medicines. Companies have had to conduct numerous trials to get two that show a positive result, which is the Food and Drug Administration’s minimum for approval.
Placebos have long been used to help scientists separate the “real” effectiveness of medicines from the “illusory” feelings of patients. The placebo effect — the phenomenon of patients feeling better after they’ve been treated with fake pills — is seen throughout the field of medicine. But new research suggests that the placebo may play an extraordinary role in the treatment of depression, where how people feel is the difference between sickness and health.
This is illustrated by a recent trial that compared the herbal remedy St. John’s wort to Zoloft. St. John’s wort fully cured 24 percent of the depressed people who received it, and Zoloft cured 25 percent — but the placebo fully cured 32 percent.
Seattle psychiatrist Arif Khan analyzed 96 antidepressant trials between 1979 and 1996. In 52 percent of them, the effect of the antidepressant could not be distinguished from that of the placebo. Khan says the makers of Prozac had to run five trials to obtain two that were positive, and the makers of Paxil and Zoloft had to run even more. The trials that were made public in the medical literature tended to show positive results, while those that didn?t weren?t released.
When Andrew Leuchter, a professor of psychiatry at UCLA. tracked some of the brain changes associated with drugs such as Prozac and Effexor and compared the brain changes in patients on placebos, he was amazed to find that many of them had changes in the same parts of the brain that are thought to control important facets of mood. Patients who got better on placebos showed heightened activity in the prefrontal lobe, and that activity continued to rise during the eight weeks of the study. Those who responded to medicine initially showed a decline in prefrontal brain activity, then a rise that eventually tapered off. Thirty-eight percent of patients responded to the placebo, and 52 percent to the medicines. Once the trial was over and the patients who had been given placebos were told they hadn?t received real medicine, they quickly deteriorated.
This doesn?t mean that antidepressants don?t work. But the results do suggest that Americans may be overestimating the power of the drugs, and that the medicines’ greatest benefits may come from the care and concern shown to patients during a clinical trial. “The drugs work, and I prescribe them, but they are not what they are cracked up to be,” says Wayne Blackmon, a Washington psychiatrist who specializes in patients who suffer from depression. “I know from clinical experience the drugs alone don’t do the job.”
The number of doctor visits for depression rose from 14 million in 1987 to almost 25 million last year, and medications were prescribed for nine in 10 patients. It?s not clear how many patients received medicines in the context of therapy, although research has indicated that combining medicines with psychotherapy produces the best results.
Randall Stafford, a Stanford University physician who conducted the study on doctor visits, found that less than one-third of them in 2001 were to psychiatrists and two-thirds of them were to primary care physicians. The former are more likely to include therapy, while the latter are less knowledgeable about therapy, more pressed for time and less likely to offer patients anything like the attention they would receive in a clinical trial.
The average participant in an eight-week trial spends about 20 hours being examined by top experts and highly trained caregivers, says Khan. Participants — including those being given sugar pills — are asked detailed questions about how they are feeling, and their every psychological change is closely noted. In comparison, the average patient with depression sees a doctor perhaps 20 minutes a month.
Timothy Walsh, a psychiatrist at Columbia University found that the placebo effect has grown in recent years. He found that greater percentages of people tended to get better on placebos during trials of antidepressants in 2000 than in 1981.
“We like to think we give people treatments and they get better,” says Leuchter. “We have this fallacy of success, but we don’t know in any individual why they get better. Undoubtedly one of those factors is the time we spend with people and the connectedness that gives patients.”
To learn how a skeptical scientist became a believer when a healer saved him from cancer, read ?Heart of the Mind? and ?Miracles of Mind? by Russell Targ and Jane Katra,click here.
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