as I understand what I'm reading in Healey's work -- his research is online, in full -- as well as that of Petersen (Our Daily Meds) and Christopher Lane (Shyness: how normal behavior became a disease), the diagnostic criteria in the DSM were under such political pressure to be rendered so vague as to encompass broad swaths of the population (because Pharma saw this as a big market) and to eradicate any reference to Freudian clinical evidence and insights, that the populations for whom anti-depressants, especially SSRIs, are being given are composed of people who have very different problems, lumped into one category and, thus, are very likely responding quite differently.
As the article on placebos I posted recently points out, sometimes it really is just that people feel they are being paid attention to. Their depression is so mild and so situational that this is about all they need to feel better. What that placebo article also pointed out, in line with a sciam review I read back in 2004, is that it's quite likely that some non-drug therapies actually do work in ways that help change the "chemical structure" of the brain. (I put the term under erasure for the same reasons that Healey calls this sort of talk "biobabble". Please don't go off the handle: he is a psychiatrists who thinks we need SSRIs and did major research on serotonin reuptake himself.)
As I understand it, from reading these three authors, there are different kinds of responses because people are different. There are different kinds of responses because people who do suffer from a serious "chemical disorder" are part of the population taking ADs, as are people like my mother, with utterly no history of depression and clearly experiencing what they call "situational" depression.
So, tossing out the placebo response as bunkem is wholly unfair to the experiences of people who _do_ respond to placebos and get better. It dosn't help us get any closer to what is going on that's for sure.
Here's a pretty good article on the placebo response which is causing drug companies a lot of hassle because it's harder and harder for them to demonstrate effectiveness against placebos. The cultural differences described in the article are fascinating.
Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why.
By Steve Silberman 08.24.09
<...> The upshot is fewer new medicines available to ailing patients and more financial woes for the beleaguered pharmaceutical industry. Last November, a new type of gene therapy for Parkinson's disease, championed by the Michael J. Fox Foundation, was abruptly withdrawn from Phase II trials after unexpectedly tanking against placebo. A stem-cell startup called Osiris Therapeutics got a drubbing on Wall Street in March, when it suspended trials of its pill for Crohn's disease, an intestinal ailment, citing an "unusually high" response to placebo. Two days later, Eli Lilly broke off testing of a much-touted new drug for schizophrenia when volunteers showed double the expected level of placebo response.
It's not only trials of new drugs that are crossing the futility boundary. Some products that have been on the market for decades, like Prozac, are faltering in more recent follow-up tests. In many cases, these are the compounds that, in the late '90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.
It's not that the old meds are getting weaker, drug developers say. It's as if the placebo effect is somehow getting stronger.
The fact that an increasing number of medications are unable to beat sugar pills has thrown the industry into crisis. The stakes could hardly be higher. In today's economy, the fate of a long-established company can hang on the outcome of a handful of tests.
Why are inert pills suddenly overwhelming promising new drugs and established medicines alike? The reasons are only just beginning to be understood. A network of independent researchers is doggedly uncovering the inner workingsand potential therapeutic applicationsof the placebo effect. At the same time, drugmakers are realizing they need to fully understand the mechanisms behind it so they can design trials that differentiate more clearly between the beneficial effects of their products and the body's innate ability to heal itself. A special task force of the Foundation for the National Institutes of Health is seeking to stem the crisis by quietly undertaking one of the most ambitious data-sharing efforts in the history of the drug industry. After decades in the jungles of fringe science, the placebo effect has become the elephant in the boardroom. <...>
more at http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all