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A pill, drug or other physical form of medicine is often assumed to be the only effective component, but could be just one of several parts of a successful treatment for depression.

A recent study conducted at the UCLA Semel Institute for Neuroscience and Human Behavior shows that an activity decrease in the front part of the brain when a patient receives a placebo suggests a better response to subsequent antidepressant treatment.

The results of the study indicate that factors other than medication, such as doctor-patient relationships, treatment expectations and the physical act of taking a pill, complete the picture for successful treatment of depression, said principal investigator Aimee Hunter, a research psychologist at the Institute.

“Most clinicians already understand treating the whole patient is important, but this is just a factual example,” Hunter said. “It provides stronger grounding for depression treatment.”

The nine-week study period consisted of 51 adult subjects with depression receiving one week of placebo followed by eight weeks of antidepressant medication.

The cordance, or measurements of electrical activity, was recorded before and after subjects were given the placebo.

Those with a decrease in the area of the brain at the top of the forehead during placebo lead-in tend to do better after eight weeks of medication, Hunter said.

“The larger the decrease, the better they did,” she said.

The fact that the subjects had already experienced a change in brain activity even without the medication suggests that they had already responded to changes in conditions from counseling or even the mere idea of treatment.

“People often respond to the infusion of hope, from struggling on your own without support,” said Elizabeth Gong-Guy, the director of UCLA Student Psychological Services.

In addition to the change in hope, the patient’s attitude toward and expectations from treatment are crucial factors, said Michelle Abrams, the research nurse who checked up on the patients each week.

“If they come in with the expectation that the pill and program will work, they tend to respond better to the placebo,” Abrams said.

Other patients responded to factors such as the simple action of taking a pill.

“The pill is tangible and it felt like I was doing something definite about my condition,” said Charles Park, a 32-year-old placebo subject in the study. “Just the fact that I was taking something and that there was an anticipated effect was helpful.”

Studies are currently being conducted to assess how important each factor is, as well as to find more refined ways of pinpointing areas of brain activity, Hunter said.

While some may respond well to such factors, others respond only to antidepressant medication. There is no definite treatment method that will work for all people, Gong-Guy said.

“The big question in psychiatry is the mystery surrounding why a certain patient gets better after medication and others don’t,” Hunter said. “This study indicates that the placebo is a major contributor to predicting how someone will do.”