There's also the question of whether counselling played any role in the patients given the placebo. Some depression is caused by physical or mental traumas experienced by the patient a long time previous to the symptoms becoming apparrent. Antidepressants alone aren't going to fix this, although they are going to help with the daily feelings of Helplessness and Loneliness. But a placebo could also help with these feelings as the patient perceives that they are getting help, and with counselling or group support helping to remove the loneliness aspect, that could be enough to break the spiral.