How To Reduce The Side Effects Of Drugs. About Placebo And Nocebo. Part 2 - Research, Quality Of Life

2023 Author: Oswald Adamson | [email protected]. Last modified: 2023-05-21 20:18

In 2006, a 26-year-old man came to the hospital and asked for help. “I drank all the pills,” he said and fell to the floor, and an empty bottle rolled out of his hands. The young man was in a lethargic state, but conscious. He said that he - a participant in a clinical trial of antidepressants - received a full bottle of pills yesterday and drank one as expected, but today he drank all the remaining 29 pills. In the end, the reason for his participation in the study is real depression, with suicidal thoughts, which arose on the basis of separation from the girl. His pressure dropped to 80/40, pulse 110. Intravenous infusion of two liters of saline raised the pressure, which, however, decreased again when the flow rate of the solution decreased. The label of the empty vial bore the doctor's details and was contacted. The urine test showedthat all vital signs are normal. The young man was kept on a drip and six liters of saline was poured in over four hours. By this time, the doctor in charge of the clinical trials arrived and determined from his papers that the man had been assigned to a placebo group and, therefore, those tablets were just cellulose and starch. The doctors informed the patient about this, the man was surprised, burst into tears, but he immediately felt better. In 15 minutes the pressure stabilized at 126/80 with a pulse of 80, and there was no trace of the previous "overdose". He was diagnosedthat the man was assigned to a placebo group and, therefore, those tablets are just cellulose with starch. The doctors informed the patient about this, the man was surprised, burst into tears, but he immediately felt better. In 15 minutes the pressure stabilized at 126/80 with a pulse of 80, and there was no trace of the previous "overdose". He was diagnosedthat the man was assigned to a placebo group and, therefore, those tablets are just cellulose with starch. The doctors informed the patient about this, the man was surprised, burst into tears, but he immediately felt better. In 15 minutes the pressure stabilized at 126/80 with a pulse of 80, and there was no trace of the previous "overdose". He was diagnosed placebo overdose (Reeves et al., 2007). This particular case is a great opportunity to better understand the placebo (and nocebo) effect.

For starters, recent research suggests that antidepressants probably don't work the way we're used to thinking. One recent analysis (Hengartner & Plöderl, 2018) showed that it is possible that they produce the advertised effect on one in nine people. In this case, the eight remaining people are exposed to senseless risks. No one argues that antidepressants have significant mental and physical effects, but there is no evidence that it cures depression. Insomnia, fatigue, loss of appetite, agitation and suicidal ideation are symptoms of depression, but these are the same symptoms that the newer antidepressants produce. In addition, there is evidence that they increase the risk of obesity, stroke, dementia, and mortality in general.

Today, there is every reason to believe that some of the unpleasant or dangerous side effects that occur when taking medications can be explained not only by the medication itself, but also by the nocebo effect.

What is nocebo

Nocebo is a mirror image of a placebo. A placebo, for example, relieves pain or leads to positive changes when taking a completely neutral substance. Nocebo, on the other hand, leads to pain, unpleasant or even dangerous consequences when taking the same substance. So, in experiments, poison ivy caused an allergic reaction with a rash and pain, although people were given completely harmless leaves

In another experiment, humans were injected with saline. Some were told that it was a saline solution, and no reaction occurred. Others were told that they were injecting an allergen, and people developed an allergic reaction, albeit slightly less violent than with a real allergen (Napadow et al., 2015).

In another study (Colloca et al., 2004), morphine was administered to patients after surgery for pain relief. Some patients were interrupted but not told about it, and the patients, without noticing anything, rested quietly without any pain. Others were told that the morphine was interrupted, and this caused bouts of pain, although there was actually no interruption. Imagine: the pain blockade by the most powerful pain relievers was easily broken with one phrase!

Lactose and gluten intolerance, which are so common these days, according to some researchers, are also examples of nocebo. No one denies the reality of the symptoms that can be confirmed by tests, but perhaps the reason for their occurrence is the image of gluten and lactose, painted so that there is one small step left before the symptoms are detected.

According to some scientists, nocebo may be stronger than placebo. According to Luana Colloca, a researcher at the University of Maryland School of Nursing, the brain needs the nocebo effect to plan its behavior in dangerous situations - to prevent something that could cause even more harm. Thus, anxiety and anxiety in small doses help a person prepare and avoid serious problems. For example, we worry about the safety of our evening route home and choose something better or get ourselves ready. But, of course, when anxiety starts to build up, the nocebo effect can spiral out of control (Heid, 2016).

There is an idea that our brain receives information about the world through the senses, but does not receive it in full and not all. Therefore, a large part of the idea of the world is built by the brain on the basis of assumptions and predictions, which are constantly checked. While such guesses are being verified or awaiting verification, they become realistically valid information. Sometimes the brain operates on erroneous information, as we saw in the example of a young man drinking a placebo. His behavior was rational and could save his life - if he drank the active medicine. But as soon as the mistake was recognized, the information was updated and the body's reaction immediately stopped.

See also: The strength of the medicine depends on the doctor. About placebo. Part 1

Therefore, when that young man was told that he was participating in a study and was taking either a real antidepressant or a placebo, he was required by the protocol to tell him about the possible side effects. The same can happen to us when the doctor either tells us about a possible reaction, or we learn about it in the instructions: "It can cause nausea, vomiting, loss of sleep, numbness of the limbs and dizziness." Scientists understand this and think about how to convey to people the necessary information about adverse reactions without causing these reactions with the nocebo effect.

Faith and expectations influence perception and become reality, a self-fulfilling prophecy that not only can happen, but, with decent probability, and occurs on a significant scale that we do not yet realize.

Sources:

• Colloca L., Lopiano L., Lanotte M., Benedetti F. Overt versus covert treatment for pain, anxiety, and Parkinson's disease // The Lancet Neurology. 2004.3 (11), 679–684. doi:
• Heid M. The 'Nocebo Effect' may be even stronger than placebo // Elemental. Medium. 14 Nov. 2016.
• Hengartner MP, Plöderl M. Statistically significant antidepressant-placebo differences on subjective symptom-rating scales do not prove that the drugs work: Effect size and method bias matter! // Frontiers in psychiatry. 2018.9.517.
• Napadow V., Li A., Loggia ML, Kim J., Mawla I., Desbordes G., Pfab F. The imagined itch: brain circuitry supporting nocebo-induced itch in atopic dermatitis patients // Allergy. 2015.70 (11). 1485-1492. doi: 10.1111 / all.12727
• Reeves RR, Ladner ME, Hart RH, Burke RS Nocebo effects with antidepressant clinical drug trial placebos // General Hospital Psychiatry. 2007.29 (3). 275-277. doi: 10.1016 / j.genhosppsych.2007.01.01