Irving Kirsch

“If you're taking an antidepressant, it's working, and you're not experiencing side effects, go on taking it. But if it's not working, or not working well enough, or if you have side effects you don't like, talk to your doctor about an alternative approach.”

“Many of the benefits of CBT (cognitive behavioral therapy) can be obtained without going into therapy. There are a number of self-help books, CDs and computer programs that have been used to treat depression and some of these have been tested in clinical trials with positive results. I can particularly recommend these two books. One is 'Control Your Depression', the lead author of which is Peter Lewinsohn, a Professor of Psychology at the University of Oregon. ... The other book that I can recommend with confidence is 'Feeling Good' by the psychiatrist David Burns. 'Control Your Depression' emphasizes behavioral techniques like increasing pleasant activities, improving social skills and learning to relax. 'Feeling Good' puts greater emphasis on changing the way people think about themselves. But both books include both cognitive and behavioral techniques.”

“The results of decades of neurotransmitter-depletion studies point to one inescapable conclusion: low levels or serotonin, norepinephrine or dopamine do not cause depression. here is how the authors of the most complete meta-analysis of serotonin-depletion studies summarized the data: "Although previously the monoamine systems were considered to be responsible for the development of major depressive disorder (MDD), the available evidence to date does not support a direct causal relationship with MDD. There is no simple direct correlation of serotonin or norepinephrine levels in the brain and mood.' In other words, after a half-century of research, the chemical-imbalance hypothesis as promulgated by the drug companies that manufacture SSRIs and other antidepressants is not only with clear and consistent support, but has been disproved by experimental evidence.”

“There are a variety of techniques to help people change the kind of thinking that leads them to become depressed. These techniques are called cognitive behavioral therapy.”

“Nocebos often cause a physical effect, but it's not a physically produced effect. What's the cause? In many cases, it's an unanswered question.”

“Anything that instills a sense of hope will at least temporarily help treat depression.”

“There seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients.”

“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.”

“Depression is partly a nocebo effect, in the sense that it can be produced by negative exceptions about oneself and the world. The way in which these negative expectations develop and produce their negative effects provides some clues as to how they can be reversed. Expectancy effects grow, feeding upon themselves. One reason this happens is that our subjective states - our feelings, our moods and sensations - are in constant flux, changing from day to day and from moment to moment. The effects of these fluctuations depend on how we interpret them, and our interpretations depend on our beliefs and expectations. When we expect to feel worse, we tend to notice random small negative changes and interpret them as evidence that we are in fact getting worse. This interpretation makes us actually feel worse, and it strengthens the belief that we are getting worse, leading to a vicious cycle in which our expectations and negative emotions feed on each other, cascading into a full-blown depressive episode. .. Positive expectancies have the opposite effect. They can set in motion a begin cycle, in which random fluctuations in mood and well being are interpreted as evidence of treatment effectiveness, thereby instilling a further sense of hope and countering the feeling of hopelessness that are so central to clinical depression.”

“Perhaps anti-depressants should be best reserved for the very extreme cases and, more importantly, for those who do not respond to alternative forms of interventions.”

“The big bulk of the response to antidepressants is the placebo response.”

“I do a lot of research on the placebo effect, not just in depression but in irritable bowel syndrome, pain, arthritis of the knee, migraine, asthma.”

“Depression is not caused by a chemical imbalance in the brain, and it is not cured by medication. Depression may not even be an illness at all. Often, it can be a normal reaction to abnormal situations. Poverty, unemployment, and the loss of loved ones can make people depressed, and these social and situational causes of depression cannot be changed by drugs.”

“Physicians do not systematically prescribe placebos to their patients. Hence they have no way of comparing the effects of the drugs they prescribe to placebos. When they prescribe a treatment and it works, their natural tendency is to attribute the cure to the treatment. But there are thousands of treatments that have worked in clinical practice throughout history. Powdered stone worked. So did lizard's blood, and crocodile dung, and pig's teeth and dolphin's genitalia and frog's sperm. Patients have been given just about every ingestible - though often indigestible - substance imaginable. They have been 'purged, puked, poisoned, sweated, and shocked', and if these treatments did not kill them, they may have made them better.”

“To someone who is not currently on anti-depressants, I would suggest trying other treatments first - for example, psychotherapy.”

“Antidepressants can have troubling side effects and are addictive for some people.”

“Patients who trust their doctors and have a psychological expectation of getting better could trigger a reaction in their body.”

“The doctor-patient relationship is critical to the placebo effect.”

“The one thing we do know is that the chemical imbalance theory - the theory that people get depressed when they don't have enough serotonin in their brain - we know that that's wrong.”

“If doctors just spent more time with their patients so they felt more reassured, that might help.”