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When trying to treat your mental health symptoms, the simple belief that you can be helped can be an important factor.
Symptoms of nine mental health disorders improved significantly under placebo treatment, according to a new review of 90 randomized controlled trials – known as a meta-analysis – totaling 9,985 adult participants, largely aged 30 to 40. .
The disorders covered in the review, published Wednesday in JAMA Psychiatry, included major depressive disorder, mania, schizophrenia, obsessive-compulsive disorder or OCD, attention-deficit/hyperactivity disorder, panic disorder, post-traumatic stress disorder and social phobia.
The placebo tablets used in the randomized controlled trials were identical in appearance and taste to the active drugs, but did not contain the active ingredient, said Dr. Tom Bschor, first author of the study and professor of psychiatry at the hospital. University of Dresden in Germany. Instead, placebos contain excipients, which are the inactive ingredients of medications.
In the past, subjecting participants with mental health conditions to placebo treatment was an ethical dilemma, given that researchers would not be treating a person’s mental health problem and it was possible that participants’ symptoms receiving placebo treatment get worse, Dr. Jonathan said. Alpert, the Dorothy and Marty Silverman Professor in the Department of Psychiatry and Behavioral Sciences at the Albert Einstein College of Medicine in New York. But there are response plans for these situations.
Because placebo participants in this analysis experienced benefits, the results support the use of placebo controls in studies, said Alpert, who was not involved in the study.
“Otherwise it would be very difficult to make sense of the data” regarding the effects of active drugs, he added. “This is the most comprehensive study of placebo effects in psychiatry.”
The results are also important for treating patients, Bschor said.
“First, the positive effect on all diagnoses shows that it can be medically and ethically justified for patients to participate in clinical trials with placebo groups in the future,” Bschor said by email. “Clinicians may encourage their patients to participate in such trials, given the risk of being assigned to a placebo.”
Additionally, the study suggests that for most disorders, initially forgoing prescription medications might be acceptable if patients have mixed feelings or anxiety about starting treatment and want to see if their condition improves. without it, Bschor said.
But for disorders that haven’t seen as much improvement with placebos — like OCD or schizophrenia, which is a psychotic disorder — medications may be more necessary.
Experts say the improvement in mental health symptoms with placebo treatment may be due to a few potential influences.
The first is “the placebo effect in the strict sense, that is, the induction of hope and belief in an effective treatment,” Bschor said by email. “Placebo is administered in randomized, double-blind studies, so participants do not know whether they might receive active medication.”
Second, the benefit of mental health professionals inquiring about a patient’s condition is “one of the most powerful effects in all of medicine,” said Dr. Richard Keefe, professor emeritus of psychiatry and in behavioral sciences, as well as psychology and neuroscience at Duke University Medical Center. in North Carolina.
Believing that things can get better can be healing, added Keefe, who was not involved in the study.
The findings could also reflect the natural history of some disorders, experts said.
“It is well known that mental disorders are episodic and symptoms can fluctuate over time and a portion of people can improve partially or completely without any treatment, placebo or intervention,” said Dr. Felipe Barreto Schuch , assistant professor of psychiatry and mental health at the Federal University of Santa Maria in Brazil, by email. “This is what we call spontaneous remission.” Schuch was not involved in the study.
The likelihood of spontaneous remission is particularly true for depression and anxiety, which have the highest spontaneous remission rates overall and are the two disorders that benefit the most from placebo treatment in this study, the experts said. .
“A major limitation is that, for methodological reasons, we cannot separate the three main influences mentioned above,” Bschor said. “Isolating the extent of the true placebo effect would require studies including a group receiving no medication, not even a placebo, alongside the placebo group. Such studies are virtually unavailable in the psychiatric field.
Why is there a difference in the effectiveness of placebos for most disorders compared to schizophrenia and OCD? Symptoms of some disorders (like sadness resulting from depression) respond better to attention and reassurance than symptoms of schizophrenia like hallucinations, Keefe said.
Biological contributions to these disorders are another factor, Alpert said.
Genetics accounts for 30 to 40 percent of the risk of developing depression or anxiety, he said. As a result, life events “have a very significant impact on the development of major depressive disorder or generalized anxiety disorder,” Alpert said. “Disorders like schizophrenia or OCD are more biological, in that 70 or 80 percent of the risk of developing these disorders appears to be genetic.”
If you have one of these disorders and are wondering which treatment, if any, would be best, know that medications always outperform placebos, Alpert said. The study just shows that if you’re in a therapeutic setting where people care about you and educate you about your illness, that’s a good start, and the drugs provide an even greater benefit, he said. added.
If you’ve never taken medication for your condition and are going without it to see if your symptoms improve over time, you should still see your doctor regularly and undergo treatment, Bschor said.
“However, if no improvement occurs after several weeks,” he added, “you should openly reconsider the need for drug treatment.”