Acute placebo responsiveness predicts longitudinal expectation effects in antidepressant treatment

Positive treatment expectations are known to enhance antidepressant efficacy. Experimental placebo studies aim to provide mechanistic insights into this association, yet their findings have not been clearly linked to clinical expectation effects within individual patients. In a randomized crossover trial, 61 participants with major depressive disorder (31 women, 30 men) completed an emotion classification task and mood assessments after administration of a saline nasal spray labeled as either oxytocin (sham oxytocin treatment, deceptive placebo) or saline (control). Forty-five participants subsequently underwent antidepressant treatment and were monitored weekly for treatment expectations and depressive symptoms, with follow-ups extending to three months. Using linear mixed-effect models, we examined trajectories of clinical expectation effects and their prediction by experimental placebo-induced changes in emotional processing. Sham oxytocin treatment acutely induced positive expectations, improved mood, and shifted emotional processing toward positivity. Longitudinal modeling revealed that weekly reductions in depressive symptoms were predicted by higher treatment expectations reported the preceding week. These clinical expectation effects were most pronounced in individuals exhibiting strong acute placebo responses in emotional processing. Overall, our findings indicate that positive treatment expectations facilitate critical aspects of emotional processing in depression and that individual responsiveness generalizes across different treatments and time windows. Experimental placebo assessments offer an ecologically valid model for elucidating mechanisms and predictors of clinical expectation effects and highlight expectation sensitivity as a promising target for treatment optimization.