Do Antidepressants Work? Or is it All in Your Head?

November 9, 2017
Anna Jankowska, LCPC

By Anna Jankowska, MA, CEAP, SAP, LCPC

Anna Jankowska is a mental health, addiction, and substance abuse counselor with over 17 years of experience and has specialized training and skill in working with individuals, groups and communities to improve mental health outcomes. NPI number: 1598843526

We recently discussed the prominence of depression as well as some of the risks involved in the use of antidepressants.   Depression and anxiety can be debilitating mental disorders, and it’s no wonder that one would go to a multitude of means to try to alleviate the suffering.  We know that exercise can affect the speed and degree of recovery for those suffering from Major Depressive Disorder, but for many, medication may seem to be the most efficient form of relief.  While medication is useful for treatment of a number of ailments physical and psychological, have you considered whether some of the benefits of these drugs are mentally influenced?   What if some of the relief you feel after taking the medication, is not real, but rather just a matter of perception.

A recent article, Antidepressants Can Work, But Only If You Believe They Will by Kelly Brogan, MD, discusses the power of the placebo effect, in which one’s beliefs can influence their health outcomes.  In this article Brogan discusses the findings of a randomized clinical trial in which people with Social Anxiety Disorder (SAD) were randomly divided into two groups: an overt and a covert group.  While both groups were given the same actual dosage of Lexapro, an antidepressant used to treat depression and anxiety, the overt group were told of their prescription while the covert group was being told they were given “an “active placebo” that had similar side effects as the SSRI but had no clinical effects”.  The results of the trial showed that “50% of people in the overt group responded to treatment, while the response rate in the covert group was a mere 14%.”  The only difference between the treatments were what they were told at the onset of the study (Brogan, 2017).

Brogan also goes on to note the brain scans of the overt group showed “showed increased neuronal reactivity in brain regions that are associated with cognition, attention, and rumination, namely the posterior cingulate cortex (PCC) and the left mid temporal and inferior frontal gyri.” She speculated that the knowledge of receiving the SSRI may have helped the participants kick off thoughts of recovery.  Meanwhile, brain scans of the covert group showed “increased activations of the amygdala and the connectivity between the amygdala and the PCC which tracked with higher levels of anxiety.” (Brogan, 2017)

The examination of how the mental affects the physical is not a new development.  In counseling, we often explore values and belief systems as part of the treatment process and examine how one’s belief’s affect their actions or the outcome of treatment.  Per a New York Times article on the effects of a positive outlook on health from earlier this year, “Studies have shown an indisputable link between having a positive outlook and health benefits like lower blood pressure, less heart disease, better weight control and healthier blood sugar levels.” This article discussed Judith T. Moskowitz and her fellow colleagues’ work on the effects of teaching the fostering of positive skills to people who are in the midst of a health crisis.  Beyond the physical affects, the positive outlook had psychological benefits, including enhanced belief in one’s abilities, a decrease in perceived stress and development of healthier behaviors (Brody, 2017).

Perhaps in the midst of medical developments, in a world where prescriptions are fairly prominent we may too quickly consider a pill to be the answer to resolving our ailments.  It may be too great of a leap to say antidepressants can only work if you believe they will, because in certain cases the medication may work very well, in conjunction with therapy.  However, it is worth considering that in other cases, medication can only take a person so far, and the rest of the way is still depended on one’s beliefs.


Brody, J.E. (2017, March 17). A positive outlook may be good for your health.

Brogan, K. (2017). Antidepressants can work, but only if you believe they will.

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