[NickM]

Keep in mind that studies find a strong effect for placebos: the numbers are not saying "these pills do nothing" they're saying "these pills seem to do a lot, but placebos do almost as much".

Obviously the effect feels extremely real to you, but we wouldn't see a strong placebo effect in the numbers if people on placebos didn't genuinely feel much better.

I get that it feels like the second drug worked much better, but expectancy effects and internal narratives are extremely strong, and they're impossible to untangle at the level of an individual.

[Johanx64]

The whole conversation is a version of "does alcohol help with depression better than a placebo?"

Because just like alcohol - so do SSRIs have a very clear, pronounced psychoactive pharmaceutical effects. It's just that both effects have little to do with "depression". For example, setraline is one of the most effective drugs for PE(Premature Ejaculation), with easily measurable effect (it can be timed!).

Do depressed people feel better when they are drunk and inebriated? Maybe, probably some do? There certainly are quite a lot of people that self medicate depression with alcohol!

Do depressed people feel better when they are zombified out of their brain with SSRIs? Probably some do?

From a certain point of view, prescribing SSRIs for depression isn't all that different from prescribing alcohol for depression. Both are hepatotoxic - pretty bad for your liver.

And is just a symptom of stone-age we live in when it comes to medicine and understanding of the human body.

[wasabi991011]

Maybe I just don't understand placebo particularly well, but why would it work on the second drug and not the first?

Separately, I think part of what is missing from this discussion is that we currently have no mechanism for prescribing placebos to a large portion of the population.

[NickM]

Placebo is an expectancy effect. I don't know all the details of OP's story, but there are all kinds of plausible reasons I can imagine that someone might have different expectations for one drug over another.

It might not even have anything to do with the drug itself: mental health issues tend to wax and wane on their own over time, so if someone happens to feel better right after starting a new medication, it's easy to think "oh hey this one must be working" and then that can trigger the placebo effect and turn into a positive feedback cycle.

[im3w1l]

For depression specifically, I could see placebo having another important effect. Agency. Taking action to resolve your problems feels good. Compare to rain dances, which while ineffective in bring about rain, surely helps reduce anxiety of the performer.