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There are a variety of techniques to help people change the kind of thinking that leads them to become depressed. These techniques are called cognitive behavioral therapy.
Nocebos often cause a physical effect, but it's not a physically produced effect. What's the cause? In many cases, it's an unanswered question.
I do a lot of research on the placebo effect, not just in depression but in irritable bowel syndrome, pain, arthritis of the knee, migraine, asthma.
Psychotherapy works, and some types of therapy have been shown to be much more effective than antidepressants over the long run.
There seem to be many causes of depression. One cause is profound loss, grief. Economic hardship we know is linked to depression. We don't have a full picture.
Depression comes back over time in about 90 percent of people on antidepressants. Studies show that relapses are far less common when people are treated with psychotherapy.
The one thing we do know is that the chemical imbalance theory - the theory that people get depressed when they don't have enough serotonin in their brain - we know that that's wrong.
There seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients.
Patients who trust their doctors and have a psychological expectation of getting better could trigger a reaction in their body.
To someone who is not currently on anti-depressants, I would suggest trying other treatments first - for example, psychotherapy.
Perhaps 10 percent of patients who are prescribed antidepressants are really benefiting from the drugs' active ingredients.
If you're taking an antidepressant, it's working, and you're not experiencing side effects, go on taking it. But if it's not working, or not working well enough, or if you have side effects you don't like, talk to your doctor about an alternative approach.
Perhaps anti-depressants should be best reserved for the very extreme cases and, more importantly, for those who do not respond to alternative forms of interventions.1