“For people who are depressed, and especially for those who do not receive enough benefit from medication of for whom the side effects of antidepressants are troubling, the fact that placebos can duplicate much of the effects of antidepressants should be taken as good news. It means that there are other ways of alleviating depression. As we have seen, treatments like psychotherapy and physical exercise are at least as effective as antidepressant drugs and more effective than placebos. In particular, CBT has been shown to lower the risk of relapsing into depression for years after treatment has ended, making it particularly cost effective.”

“Psychotherapy works for the treatment of depression, and the benefits are substantial. In head-to-head comparisons, in which the short-term effects of psychotherapy and antidepressants are pitted against each other, psychotherapy works as well as medication. This is true regardless of how depressed the person is to begin with. Psychotherapy looks even better when its long-term effectiveness is assessed. Formerly depressed patients are far more likely to relapse and become depressed again after treatment with antidepressants than they are after psychotherapy. As a result, psychotherapy is significantly more effective than medication when measured some time after treatment has ended, and the more time that has passed since the end of treatment, the larger the difference between drugs and psychotherapy.”

“Like antidepressants, a substantial part of the benefit of psychotherapy depends on a placebo effect, or as Moerman calls it, the meaning response. At least part of the improvement that is produced by these treatments is due to the relationship between the therapist and the client and to the client's expectancy of getting better. That is a problem for antidepressant treatment. It is a problem because drugs are supposed to work because of their chemistry, not because of the psychological factors. But it is not a problem for psychotherapy. Psychotherapists are trained to provide a warm and caring environment in which therapeutic change can take place. Their intention is to replace the hopelessness of depression with a sense of hope and faith in the future. These tasks are part of the essence of psychotherapy. The fact that psychotherapy can mobilize the meaning response - and that it can do so without deception - is one of its strengths, no one of its weaknesses. Because hopelessness is a fundamental characteristic of depression, instilling hope is a specific treatment for it it. Invoking the meaning response is essential for the effective treatment of depression, and the best treatments are those that can do this most effectively and that can do without deception.”

“Not only are poor, unemployed, less will-educated and non-white people more likely to become depressed, but they are also least likely to benefit from treatment by either antidepressants or psychotherapy. That is why combating depression requires more than merely providing effective treatment for those who are already suffering from it. We also need the change the social conditions - such a racism, unemployment, poverty, unaffordable housing, and lack of adequate education - that put people at increased risk of becoming depressed.”

“When conventional medicine fails, when we must confront pain and death, of course we are open to other prospects for hope.And, after all, some illnesses are psychogenic. Many can be at least ameliorated by a positive cast of mind. Placebos are dummy drugs, often sugar pills. Drug companies routinely compare the effectiveness of their drugs against placebos given to patients with the same disease who had no way to tell the difference between the drug and the placebo. Placebos can be astonishingly effective, especially for colds, anxiety, depression, pain, and symptoms that are plausibly generated by the mind. Conceivably, endorphins -the small brain proteins with morphine-like effects - can be elicited by belief. A placebo works only if the patient believes it’s an effective medicine. Within strict limits, hope, it seems, can be transformed into biochemistry.”

“In 2004, the FDA urged drug companies to adopt a 'Don't ask, don't tell' policy with respect to their clinical-trial data showing that antidepressants are not better than placebos for depressed children. If the data were made public, they cautioned, it might lead doctors to not prescribe antidepressants. The FDA believed that the jury was still out on antidepressants for children. Even if the clinical trials show negative results, an FDA spokesperson was reported to have said to a Washington Post reporter, it doesn't mean that the drugs are ineffective. The assumption seems to have been that doctors should prescribe medications that have not been shown to work, until it has been proven that they don't work.”