The universal model for depression is that it a chemical imbalance in the brain. I have serious reservations about the value of that model.

The core problem with the idea is that it is disempowering. The message is “you can’t help yourself get better.”

What thoughts that follow once a person believes that their depression is due to a chemical imbalance?

  • I’m broken.” Since my brain is what I use for all of my thoughts and memories, I’m basically defective.
  • There isn’t anything I can do.” Chemistry is complicated; I don’t understand it, so how can I do anything to help?
  • It’s not going to go away on its own.” Since my brain is a bunch of microscopic neurons firing, they’re not going to fix something as severe as a chemical imbalance.
  • It’s a medical problem.” Doctors are the ones who treat medical problems, so I need a psychiatrist and medications.

When you cut your hand, you know what is hygienic. Rinse it in water. Keep it clean and cover it with a bandage. Watch for signs of infection or use an antibiotic ointment.

A person can be suffering and depressed. Today, the person learns very few tools for recovery. There isn’t any hygiene to practice; no prevention strategies.

A treatment plan might be little more than not to get worse. The tacit meaning of “chemical imbalance” is that a depressed person needs to look to doctors. Then, people with letters after their name can help make the best of it.

Although this can be an appropriate treatment, the model for a disease needs to be useful.

“Chemical imbalance in the brain” is glib. It rolls of the tongue so easily that it doesn’t get inspection. However, it doesn’t help anyone understand depression nor take action.

The Anti-Placebo Effect

There’s been plenty of information about the placebo effect the past few days. Some researchers are investigating the genetics of the placebo effect. Even the idea of drug-placebo interactions are on the table for discussion. I’ve seen the suggestion that it makes sense to have an additional treatment track in a drug trial: the drug, the placebo and a new “no treatment at all” track.

xkcd today has this amusing take on evaluating the placebo effect.

They work even better if you take them with our experimental placebo booster, which I keep in the same bottle.

xkcd May, 19, 2015

I had some recent experiences that might hint that there is an anti-placebo effect. With the placebo effect, the mind’s expectations modulate the properties of a pill. So, it seems to follow that normally effective drugs might have negative properties that are modulated by the mind.

This is different from the placebo/anti-placebo are imaginary or “all in your head.” A placebo is effective because there are biological consequences of the act of taking a medicine beyond the chemical properties of the drug.

I was talking to a nurse from my cardiologist’s office about headaches. I mentioned the headaches earlier to her earlier and she wondered why I hadn’t yet talked to my primary doctor about them. Almost immediately, my headache became worse until the phone call receded from my attention. A few days later, my doctor prescribed a medicine. Its effect of increased pain is similar to what happened after the conversation with the nurse. My symptoms get worse when I take the prescription medicine. An anti-placebo effect could even increase the likelihood of the side effects of a medicine developing.

So, with my headaches, I’m finding taking a small dose of Tylenol is more effective than the prescription medicine. I don’t think the dose I’m taking is enough to really have any direct effect and part of its effectiveness is a placebo effect.

How I discuss that with the doctor escapes me. “Hi doctor, I’m taking this tiny dose of acetaminophen and it working a lot better than the prescription medicine you ordered. I think part of its effectiveness is that it is having a placebo effect on my headaches.” I can only imagine that conversation going badly. “Err, we should try a different medicine that doesn’t have the same effects as the medicine I’m avoiding. Don’t take the Tylenol.” How do you talk to a doctor about placebos being effective in my case?

I’ve read that doctors think of the placebo effect as “cheating” or somehow improper. An anti-placebo for a specific individual might explain the appearance of side effects of a medicine.

Would an anti-side effect placebo be able to prevent the anti-placebo side effects of a regular drug? Perhaps an anti-side-effect placebo can be a good idea in patients that respond well to placebos.

It seems plausible.