APT -- eLetters for Vallance, 12 (4) 287-296

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Articles:
Aaron K. Vallance
Something out of nothing: the placebo effect
Adv Psychiatr Treat 2006; 12: 287-296 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Placebo Effect: Why Not?: Vincent O. Udenze, Prathibha Rao (13 August 2006)

Placebo Effect: Why Not? 13 August 2006

Vincent O. Udenze,
Psychiatrist ,
Prathibha Rao
Send letter to journal:
Re: Placebo Effect: Why Not?

vudenze{at}yahoo.com Vincent O. Udenze, et al.

This is a very interesting article which clearly demonstrates the existing relationship between physiological and psychological processes in achieving a placebo effect. The depth of this article raised two questions in our minds, which we would like to share;
1. What is the role of the placebo effect in side effects of medication? Does the placebo effect increase over time by the interplay of physiological and psychological processes? As an example, some atypical antipsychotics are well documented to have weight gain as an important side effect. By informing patients about this side effect and regularly asking related questions in outpatient clinics, could we be increasing the incidence and severity of this side effect through a placebo effect based on expectation.
2. If the placebo effect is statistically and clinically significant compared to no treatment, then why are placebos not recognised as medications one can prescribe to a patient? There is an ethical dimension to this question, but in situations when we do not feel able to further increase the dose of a medication, could there be a role for adding a placebo?
The purported mechanisms underlying the placebo effect including anxiety reduction, expectation, transference, “meaning effect”, and conditioning all seem to be founded on psychological processes. This emphasises why psychotherapy needs to be an integral part of our training. The understanding of these mechanisms is a tool we use in practice. No wonder one of the most important factors for success in a psychotherapeutic intervention is the therapeutic relationship between the therapist and the patient.