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[Believe in what you practice].

Iris E Sommer1,2, Andrea W M Evers3

  • 1Rijksuniversiteit Groningen-UMC Groningen, afd. Neurowetenschappen en afd. Psychiatrie, Groningen.

Nederlands Tijdschrift Voor Geneeskunde
|July 25, 2018
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Summary
This summary is machine-generated.

Antidepressants show benefits beyond placebo. However, the patient-physician relationship and patient hope significantly influence treatment outcomes, sometimes more than the medication itself.

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • Antidepressants are proven more effective than placebo in controlled trials.
  • Clinical practice involves both specific drug effects and non-specific effects (e.g., therapeutic relationship, patient hope).

Purpose of the Study:

  • To analyze the relative contributions of specific antidepressant effects and non-specific factors in clinical outcomes.
  • To highlight the importance of the therapeutic alliance in antidepressant treatment.

Main Methods:

  • Review of meta-analysis findings on antidepressant efficacy.
  • Analysis of clinical practice dynamics, contrasting with placebo-controlled trial methodologies.

Main Results:

  • Non-specific effects, including the therapeutic relationship, significantly contribute to treatment outcomes.
  • Physician's conviction and patient's hope can enhance or diminish treatment effectiveness.
  • In some cases, psychiatrist's influence on outcome exceeded the combined effect of verum and placebo.

Conclusions:

  • Choosing the right psychiatrist is as crucial as selecting the appropriate antidepressant.
  • A positive therapeutic relationship and strong patient-doctor belief foster placebo effects, enhancing treatment success.
  • Negative physician attitudes can lead to nocebo effects, undermining antidepressant efficacy.