Study Finds Beliefs About SSRIs Can Alter Their Efficacy

A person’s belief about selective serotonin reuptake inhibitor (SSRI) antidepressants, a popular class of antidepressant drugs, may affect treatment outcomes, according to a study published in EBioMedicine. The study looked specifically at the SSRI escitalopram, which is sold under the name Lexapro.

Some researchers have argued the benefits of SSRIs are due to the drugs’ placebo effects. However, studying the role of the placebo effect can be challenging. Study participants may learn they are taking the studied drug, not the placebo, when they begin to experience side effects. This study attempted to alter participants’ expectations about antidepressants to explore how the placebo effect and expectations can change treatment outcomes.

How Beliefs About SSRIs Can Affect Treatment

The study followed 46 adults with social anxiety. Groups were randomized to receive either “overt” or “covert” treatment.

The overt treatment group was treated with escitalopram. Treatment providers offered them accurate information about the effects of the drug. The covert treatment group also received escitalopram. But in this scenario, doctors told them they were receiving an “active placebo” designed to cause side effects, but not to treat social anxiety.

Both groups underwent treatment for nine weeks. Each completed measures of social anxiety at the beginning of the study and one, three, six, and nine weeks into the study. Participants also participated in functional magnetic resonance imaging (fMRI) brain scans to assess their brains’ response to treatment.

People in the overt treatment group experienced significantly better treatment results, with an overall response rate that was more than three times higher than the covert group. FMRI scans suggested there might be a neural basis to the different outcomes. This means that expectations about treatment outcomes might alter the way the brain behaves in response to treatment.

The study’s authors believe their results point to a strong placebo component of SSRI treatment. This does not mean that SSRIs are ineffective. Rather, it points to the role of beliefs and presentation in treatment outcomes.

Reference:

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. doi:10.1016/j.ebiom.2017.09.031

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