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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, Paxul and Zoloft work. And so do sugar pills. A new analysis has found that in the majority of trials conducted by drug companies in recent decades, sugar pills have done as well as -- or better than -- antidepressants. 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. What's more, the sugar pills, or placebos, cause profound changes in the same areas of the brain affected by the medicines, according to research published last week. One researcher has ruefully concluded that a higher percentage of depressed patients get better on placebos today than 20 years ago. Placebos -- or dud pills -- 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 dud 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 spells the difference between sickness and health. The new research may shed light on findings such as those from a trial last month that compared the herbal remedy St. John's wort against 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. The confounding and controversial findings do not mean that antidepressants do not work. But clinicians and researchers say 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 -- a context that does not exist for millions of patients using the drugs in the real world. "The drugs work, and I prescribe them, but they are not what they are cracked up to be, " said Wayne Blackmon, a Washington psychiatrist whose practice largely comprises patients who suffer from depression. "I know from clinical experience the drugs alone don't do the job." Still, drugs may have become the reflexive treatment for the vast majority of Americans receiving medical attention for depression: As the number of doctor visits for depression rose from 14 million in 1987 to almost 25 million last year, medications were prescribed for nine in 10 patients, according to research published last week. It is not clear how many patients received medicines in a context of therapy, although research has indicated that combining medicines with psychotherapy produces the best results. But Randall Stafford, the Stanford University physician who conducted the study on doctor visits, found. In 2001, a united states district court held there was sufficient evidence to support finding that homicides and suicide were caused by paxil and denied a motion for a new trial.
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