Placebo effect and antidepressants: A review enlightened by psychoanalysis

Scientific medicine regards placebo prescription as a lack of treatment, a control condition required to validate new therapies. However, recent studies show that placebo treatments induce beneficial effects that are larger than those observed during spontaneous healing, especially regarding depression, anxiety and other mood disorders. Here we review this literature, including meta-analyses showing that, except for severely depressed patients, placebo treatments are as effective as antidepressants. Then, we review studies concerning the conditions that modulate the size of the placebo effect in depression. We emphasize studies showing that a neurobiological conception of depression, held either by patients or their physicians, impairs healing. These observations call for considering the placebo effect as resulting from an interpersonal relationship that should be interpreted in reference to the psychoanalytical concept of transference. During a placebo treatment, the patient exchanges the medical acknowledgement of his patient status for a temporary improvement of his symptoms, but his transference is not taken into account by his physician. Actually, psychodynamic and cognitive-behavioral psychotherapies induce lasting improvements compared to placebo or antidepressant treatments. According to our interpretation, when psychotherapists take care of patient transference, including its heavy emotive power, their patients become conscious of their unconscious repetitions stemming from childhood and are able to free themselves from them. We conclude by a few suggestions regarding the training of psychotherapists and the excessive medicalization of psychic distress. (C) 2013 Elsevier Masson SAS. All rights reserved.