The power of belief: How presentation affects antidepressant efficacy

Friday, June 7, 2024.

Did you know that the effectiveness of antidepressants might hinge more on belief than on the pill itself?

Research reveals that 3X as many people respond positively to antidepressants if they believe the drug will work.

This intriguing finding underscores the significant role of expectations in treating depression and anxiety.

Belief vs. Reality

Participants in the study were given escitalopram, a common SSRI antidepressant sold under names like Lexapro and Cipralex.

Here's the twist: half of the participants were deceived into thinking they were taking an inert placebo engineered to mimic the side effects of a real antidepressant without any therapeutic benefits.

Dr. Vanda Faria, the study's first author, stated:

“Our results show that the number of responders was three times higher when correct information was given than when patients thought they were treated with an ineffective active placebo, even though the pharmacological treatment was identical.”

Mind over matter: the brain's response

Brain scans from the study revealed systematic differences in brain activity between the two groups. This indicates that expectations can influence biological responses to treatment. Ms. Malin Gingnell, a co-author of the study, explained:

“This may reflect an interaction between cognition and emotion as the brain changes differently with medication depending on the patient’s expectancies.”

Professor Tomas Furmark, who led the study, emphasized:

“We don’t think SSRIs are ineffective or lack therapeutic properties for anxiety, but our results suggest that the presentation of the treatment may be as important as the treatment itself.”

The broader implications

This study's findings raise fascinating questions about how belief can be harnessed to alleviate maladaptive states of mind. If positive expectation can triple a drug's efficacy, what other areas of mental health could benefit from a similar approach?

Recruiting Belief in Other Ways

Consider the potential of therapies that leverage belief.

Cognitive-behavioral techniques, mindfulness, and even placebos might play a crucial role in treating conditions where conventional medication falls short.

Given that antidepressants only work for about 50% of people, optimizing the way treatments are presented could significantly enhance their effectiveness.

The power of presentation

This study suggests that how we present treatments to patients can be as crucial as the treatments themselves. By fostering positive expectations, we can potentially improve the outcomes for those battling depression and anxiety.

So, the next time you hear about the latest wonder drug, remember: a little belief might just go a long way.

Whether or not antidepressants work may depend significantly on how doctors present them to patients, according to this research.

Dr. Vanda Faria, the study's first author, explained:

"Our results show that the number of responders was three times higher when correct information was given than when patients thought they were treated with an ineffective active placebo, even though the pharmacological treatment was identical."​

Moreover, brain scans revealed systematic differences in brain activity between the two groups, highlighting the biological impact of expectation. Ms. Malin Gingnell, co-author of the study, added:

"This may reflect an interaction between cognition and emotion as the brain changes differently with medication pending on the patient’s expectancies."​

Professor Tomas Furmark, who led the study, emphasized the implications of these findings, stating:

"We don’t think SSRIs are ineffective or lack therapeutic properties for anxiety but our results suggest that the presentation of the treatment may be as important as the treatment itself."​

The study, published in EBioMedicine, highlights the profound influence of verbal suggestions and patient expectations on the efficacy of antidepressants and points towards a biopsychosocial model of treatment.

Final thoughts

This approach recognizes that psychological and social factors, in addition to biological ones, play a crucial role in the effectiveness of medical treatments​. My take on this is that we need to focus more on how the human capacity for belief and certainly inhibits or expands symptom relief.

The findings suggest that doctors might need to hone their acting skills, perhaps channeling their inner Oscar winners, to maximize the effectiveness of treatments. After all, a little drama could go a long way in medicine.

But in all seriousness, this research underscores the importance of how we perceive treatments and the potential for non-pharmacological interventions to play a critical role in alleviating mental health issues.

Be Well, Stay Kind, and Godspeed.

REFERENCES:

Faria, V., Gingnell, M., Hoppe, J. M., Hjorth, O., Alaie, I., Frick, A., ... & Furmark, T. (2017). Do you believe it? Verbal suggestions influence the clinical and neural effects of escitalopram in social anxiety disorder: A randomized trial. EBioMedicine, 24, 179-188. https://doi.org/10.1016/j.ebiom.2017.09.031