In one of the books reviewed, The Emperor's New Drug: Exploding the Antidepressant Myth, Irving Kirsch has carefully examined clinical trials of popular antidepressants, and reveals that placebos could be as much as 82% as effective as the drugs themselves. He also posits that the trial participants getting the placebo could deduce that that's what they were getting, because they didn't have any side effects. So:
To further investigate whether side effects bias responses, Kirsch looked at some trials that employed “active” placebos instead of inert ones. An active placebo is one that itself produces side effects, such as atropine—a drug that selectively blocks the action of certain types of nerve fibers. Although not an antidepressant, atropine causes, among other things, a noticeably dry mouth. In trials using atropine as the placebo, there was no difference between the antidepressant and the active placebo. Everyone had side effects of one type or another, and everyone reported the same level of improvement.
This is extremely alarming to me, and makes me wonder who the trial participants were. The book reviewer doesn't go into it, but I hope Kirsch does (I haven't bought his book yet). Who suffering from severe depression would agree to a clinical trial in which they may only receive a placebo? Because I wouldn't. I don't know very much about how these trials are conducted, but would someone without health insurance be more likely to sign up? (I'm assuming treatment is free?)
Last summer, I dated a guy who prided himself on going with the flow and living in the moment. One night at dinner he told me why he doesn't have health insurance: because it's all a big scam and if he was on the brink of death, he could always go to the ER, and it would be illegal for them to refuse him treatment because he couldn't pay. I listened and nodded, silently infuriated.
Finally I said, "It's fine for you to say all that because you've never been seriously ill. I have to have health insurance."
"Why?" he said.
"Because I'm mentally ill," I said.
He burst out laughing. "Is that how you think of yourself?"
"It's not how I think of myself, it's just true."
Last year, I spent over five thousand dollars on health-related costs. This was with insurance.