Placebo as a treatment for depression.

The placebo response rate in depression consistently falls between 30 and 40%. Among more severely depressed patients antidepressants offer a clear advantage over placebo; among less severely depressed patients and those with a relatively short episode duration the placebo response rate is close to 50% and often indistinguishable from the response rate to antidepressants. In the treatment of depression none of the psychotherapies have consistently been shown to offer an advantage over pill placebo. This is not entirely surprising given the fact that the common, and arguably the therapeutic, features of the psychotherapies (expectation of improvement, support, mobilization of hope) are provided with pill placebo treatment. The placebo response in depression has been viewed as a nuisance rather than as a therapeutic and research opportunity. I propose that the initial treatment for selected depressed patients should be four to six weeks of placebo. Patients so treated should be informed that the placebo pill contains no drug but that this treatment can be helpful.