Medication Monday: Placebos 

It sadly is not a trick of the mind. It is in fact Monday again. But that doesn’t just mean that it is time for most of us to go back to work. It also means it is time for another Medication Monday, the weekly series that provides brief introduction to mental health medications. Although this week, we are looking at something that we merely believe is a medication. This week we are looking at the placebo effect. 

placebo
Photo from Adobe Stock Images, used under a creative commons license.

Research has shown that placebos seem to have their greatest impact on the subjective symptoms of a disease, such as pain and despair (Note: pain is real, but how our brains interpret pain and how we tolerate is subjective). As such, it should be no surprise that they seem to have their greatest impact on mental disorders, although research shows that the actual impact of them varies greatly. For example, response rates are below 20 percent in obsessive-compulsive disorder, and are similarly low for schizophrenia, dementia, and severe depression. However, for moderate depression and generalized anxiety disorder, nearly half of those studied showed improvement, which is similar to actual medication. 

However, this doesn’t mean we don’t need actual medication. On the contrary, there certainly is a function that true medications play that placebos can’t. Furthermore, there is a great deal we don’t know about why certain medications work and a great deal we don’t know about the placebo effect as well. It could mean that those conditions showing a smaller response rate somehow impact the brain differently, it could be that the brain is able to heal itself in some cases and not others, or it could be some other cause and effect altogether that we don’t know. 

Perhaps it means that doctors could prescribe placebos for their entry level treatment, but that comes with great ethical risk if you are telling a patient that they are receiving one thing but are really receiving another. When placebos are used in clinical trials, the recipients are made aware of the possibility that they aren’t receiving an active agent, and they accept that risk as part of the study. However, crafting informed consent for placebos would be problematic at best in actual practice. 

Nevertheless, this possibility raises numerous questions, questions that can and should be converted into research avenues as we continue to unlock the mysteries of the mind. The fact is that some of these areas of inquiry are still in their infancy, relatively speaking, and undoubtedly new discoveries regarding the impact of placebos and the impact of active medications await just us just over the horizon. 

Furthermore, this doesn’t mean that you should just go giving a sugar pill to a friend or family member dealing with mental illness. Nor should you accept strange pills from a friend or family member. Although they aren’t real medications, research shows that they can have real impacts, which is why only trained professionals should be using placebos with their patients. 

Lastly, as I always remind everyone, Medication Monday is not meant as a substitute for medical advice or medical research. Rather, it is a brief informative introduction to medications used to treat mental illness. Hopefully, these discussions will not only educate, but will also de-stigmatize mental health medication. 

 

And as always, thanks for reading.

 

Source(s):The Placebo Effect in Psychiatric Practice, Bernstein, M., Ph.D et al. (2015).

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