This study by Sinyor et al. reviewed 56 studies of antidepressants versus placebo and found that active drugs physiologically generated more neurological, sexual and anticholinergic side effects. No differences between drug and placebo were found for generating more psychic symptoms, pain symptoms, or weight gain suggesting that if remarkable complaints exist post dosing that these may be nocebo in origin. A nocebo effect occurs when negative expectations in the patient’s mindset creates artificial or psychic-based side effects.
Thomas L Schwartz, MD
Interestingly in large psychotropic trials, up to a quarter of subject will discontinue the placebo treatment due to side effects. In clinical practice, this also means that many of our patients may quit their medications early or we may discontinue them early allowing for poor dosing and likely poor outcomes. More interventional research about anti-nocebo interventions (identifying those at nocebo risk, tailoring information during informed consent, positive framing of side effect percentages, etc.) are warranted and could lead to more days on drug per patient and ideally better outcomes for them as well.
Thomas L. Schwartz, MD
Senior Associate Dean of Education
Interim Chair/Professor of Psychiatry
SUNY Upstate Medical University