Confusing brain and placebo effects of antidepressants

Jo Moncrieff in her new book Chemically imbalanced (see eg. previous post) discusses Peter Kramer’s 1993 book Listening to Prozac (see Wikipedia entry), which I mentioned in a previous post. As the New York Times said at the time (see article) Kramer’s best seller described “how Prozac … transformed his patients, making them calm, confident, cheerful and somehow better than well”. Jo admits that the miraculous transformations reported could have been “largely a function of the hype accompanying the introduction of a new medication” in the same way “as those described by Roland Kuhn in relation to imipramine” (see previous post). But she also uses Kramer’s book to support her speculation that antidepressants reduce people’s emotional sensitivity.

I have expressed concern before about how Jo talks about SSRIs causing emotional numbing or reduced emotional sensitivity (see eg. previous post). I agree there is a sense in which the placebo effect does not really deal with people’s underlying emotional problems. But Jo wants to argue that antidepressants work through their brain effects as well as their placebo effects. This is because she wants to build on her distinction between the disease-centred and drug-centred models of psychotropic drug action. I think it is possible to have an outcome-based understanding of antidepressant drug action without necessarily postulating that antidepressants work through their brain effects (drug-centred model in Jo’s terms) (see previous post). Antidepressants can be powerful placebos because of their effects caused through how people understand them (see eg. previous post).