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

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

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.

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.

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.

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