Recently, a team of researchers set out to study the antidepressant effects of ketamine and stumbled upon a medical phenomenon.
A double-blind study at Stanford University School of Medicine recruited patients undergoing elective surgery who also suffered from depression. All agreed to receive ketamine while under anesthesia and report the effects on their mood during recovery.
We were interested as anesthesiologists in optimizing patients before their surgeries, and we knew that ketamine was a very fast antidepressant, says Theresa Lii, a clinical scientist at Stanford University and one of the lead authors of a study published last month in Nature Mental Health.
To better assess the results, half of the participants were given a saline placebo. Because they were asleep, none of the participants knew whether they had received the real drug or a sham saline placebo.
What we predicted was that patients who received ketamine would be less depressed after surgery, and patients who received a placebo would have essentially no change, Lii says.
That didn’t really happen. After surgery, a significant number of participants who received ketamine found that their mood improved after surgery. One patient described the effect as life-changing. Issue? That patient was in the placebo group. In fact, the placebo group and the ketamine group had the same positive results after treatment.
What the research team stumbled upon was an antidepressant implanted in the brain. This is called the placebo effect.
What exactly are placebos?
Placebos are commonly known as fake drugs that researchers use to measure the effects of real drugs. In these settings, their purpose is to not Work. But sometimes they work surprisingly well. They may even be as effective as other pain relievers.
Based on brain mapping studies, the placebo effect occurs within the same dopamine-related brain mechanisms that respond to opiates or ketamine.
I like to present the placebo not just as a magical or mysterious thing, but as a resource of our brain, says Luana Colocca, Ph.D., director of the Placebo Beyond Opinions Center at the University of Maryland.
How can placebo pills improve certain health conditions?
Although it can’t shrink tumors or spontaneously repair muscle tissue, studies suggest that the placebo effect can treat everything from nausea and pain to depression and even symptoms of IBS, Parkinson’s disease, and glaucoma.
In other words, there is an internal pharmacy within our brain that we can access, given the right set of circumstances. Those circumstances are key to Collocasa’s research, which it recently published as an open-source compendium of placebo studies.
Through virtual reality tools and brain mapping, she discovered that genetics, psychological tendencies and cultural beliefs can contribute to placebo responses.
In the West, placebo effects are more likely to occur when the treatment is more invasive or expensive, Colloca says. The idea that it is a better treatment with a higher value plays an effective trick on the mind.
Colloca also found that simply witnessing someone else feel better can trigger our positive placebo responses. When we observe that a person is feeling better, there is an activation of the temporoparietal junction in the brain, says Colloca. So somehow we don’t have to go through the experience to notice the benefits, but just observing in another person we can activate it ourselves.
The personality of the patient and the behavior of the doctor at the bedside play a big role
When it comes to psychological profiles, she found that patients who are more prone to catastrophizing or have a greater fear of pain have lower placebo effects, while those who believe the treatment will work or feel they are being properly cared for have a greater placebo response.
Because the response to pain relief is directly related to emotional processing, trust in the health care provider or belief in the efficacy of the treatment may increase the placebo potential.
Jeremy Howick, an epidemiologist who runs the Stoneygate Center for Empathic Healthcare at the University of Leicester (UK), points to empathy as a major factor.
You can have a placebo effect without placebo pills, he tells Yahoo Life. If someone gets better because of a placebo pill, it’s not the pill itself that works, but their beliefs, their anticipation, their brain changes in anticipation that something good will happen and that can cause the heart to change and the inner pharmacy to be activated.
In a new book by Howicks, The power of the placeboto be published on November 14, it argues that bedside manner is not just a matter of bonus points for doctors, but a critical aspect of their care.
We need to teach doctors to have better communication with patients and practice empathy, he says. This is something that modern medicine forgets, because we only focus on the physical aspects of healing. It is easy to forget that there is a real person you are treating.
Communication and empathy in the healthcare setting these two factors may help explain the results of the ketamine study.
In a system where people usually go through this surgical assembly line system, we did a trial that really required us to stop and examine the patient, listen to everything they had to say about their medical and psychiatric history, and watch them throughout the process. , says Dr. Boris Heifets, a professor at Stanford University and one of the lead authors of the ketamine study. It is this process that can have a greater impact.
Those interactions may have helped patients feel more attentive and more likely to believe that the treatment would work for their depression, in effect optimizing the placebo response.
Even knowing you’re taking a placebo can help
Ironically, the placebo’s reputation has long been associated with deception. As a standard control in drug trials, the placebo depends on the belief that the fake drug is real. But do you have to be deceived for the placebo effect to work? Not necessarily.
In several recent studies, participants were transparently given placebos to treat everything from opioid use disorder and low back pain to IBS. They were also explained how the placebo effect works, evidence of its healing mechanism, and given verbal cues to explain and encourage the potential for a positive outcome.
The results strongly suggest that the placebo effect works just as effectively when participants know they are taking a sugar pill. The pill is just one part of treatment, as necessary, these studies suggest, as are interactions with health care professionals and understanding through evidence-based explanations that treatment can work when taken accordingly.
Called an open placebo, these transparent interactions may hold promise as drug-free treatments with the potential to reduce reliance on drugs with negative side effects or addiction.
Will we soon be picking up a placebo at our local pharmacy?
Despite the results of his ketamine/placebo study, Heifets is skeptical. “I don’t see a time when placebos will ever be used as an intervention,” he says. The stigma surrounding it is too great.
However, he sees the potential for larger changes in health care in response to placebo research, which highlights the importance of doctors showing more empathy and taking the time to listen to their patients. For example, encouraging doctors to spend more time with individual patients instead of attracting as many patients as possible.
In today’s health care system, there is a lot of pressure to accommodate more and more patients, condensing consultations into 10-minute virtual visits, Lii says. Will this trend really be harmful? Will we see worse outcomes in terms of mental health or pain? We do not know.
But some placebo researchers, like Koloka, can envision a near future where placebos have a place in our medicine cabinets. Her hope is that in five to 10 years we may have a personalized approach in which patients prone to positive placebo responses could supplement traditional medications with ones their bodies naturally produce.
Howick shares those hopes. If you can take something to make you feel better without worrying about becoming addicted, he says, why wouldn’t you?
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