Patients with panic attacks who respond positively to placebo have a number of personality traits and clinical characteristics. It has not been found that there is a link between personality traits and spontaneous panic attacks. More pathological abnormalities in personality traits were found in patients who stopped taking placebo after 3 weeks than in those who took placebo for longer. From our observations, we know that it is almost impossible to predict an improvement in a particular patient after placebo. Patients who had an almost invariable significant therapeutic effect from one drug, for example alprazolam, often did not respond to drugs from other groups, for example imipramine, which are highly effective in other patients with very similar symptoms. Simplifying the picture, all patients could be roughly divided into “alprazolam-sensitive” and “imipramine-sensitive.” Short-term replacement of imipramine with placebo was most often not accompanied by a worsening of the condition, but replacement with alprazolam almost always resulted in a resumption of panic attacks, although much less intense. The role of the personality of a patient with panic attacks in placebo reactivity and the characteristics of the placebo effect in agoraphobia have been specifically investigated.

The antidepressant placebo effect ranges from 30 to 40% of cases; in patients with shorter and less profound episodes, it can reach 50% and be practically indistinguishable from the most effective antidepressants. None of the types of psychotherapy surpassed placebo in terms of magnitude and quality of antidepressant effect, which the author does not consider surprising, since placebo promotes expectations of improvement, supports, mobilizes hope, etc. In general, improvement occurs against placebo in about one third of depressed patients, while taking antidepressants in about two thirds. Approximately one third of patients with major (endogenous) depression, starting from the second week of taking placebo, showed a significant improvement in symptoms that lasted for 8 weeks. The dynamics of improvement of symptoms in patients with depression in the first weeks of treatment with antidepressants and in subsequent weeks are different. A retrospective assessment of the pattern of changes in the condition of 263 patients, assessed once a week for 6 weeks, found that there were more dramatic improvements in the first 2 weeks than gradual ones, they were less persistent; this pattern was the same for placebo and antidepressants. The improvements that occurred after 3-5 weeks were more persistent than the initial shifts, and they exceeded the positive placebo effect. Continued placebo administration after a 10-day period, when a positive placebo effect was observed in patients with mild or moderate depression, did not reduce the incidence of relapses compared with patients who stopped taking placebo. After taking alprazolam, imipramine, and placebo for 6 weeks in double-blind follow-up, outpatient patients with depression experienced a decrease in Hamilton scale symptoms of more than 50%, respectively, in 50; 38.2% and 17.7% of cases. Due to side effects, 8 patients receiving imipramine, 6 receiving alprazolam, and one patient taking placebo stopped taking medications prematurely. The placebo effect depended on the duration of depressive episodes (chronicity): it was low (22.6%) in patients with periods of depression lasting 1 year or longer and high (44.9%) in those with significantly shorter episodes of depression. It is suggested that patients should be treated with placebo pills for the first 6 weeks and that they should be informed that although they receive a placebo, such treatment can help them. This recommendation is based on information that the true thymoanaleptic (mood-boosting) effect of antidepressants is characterized by a 2-week delay in improvement, while the positive placebo effect is characterized by rapid but transient improvement. The gradual improvement on placebo may be due to a coincidence with spontaneous remission. The placebo effect in moderate depression differs from the placebo effect in people complaining of constant fatigue. A faster-than-usual recovery from depression may not be a placebo effect; it depends on certain personality traits, nonverbal interpersonal processes, and is predictable. The probable predictors of a positive placebo effect in depression have been analyzed in detail. It was very difficult to answer the question of whether light treatment of seasonal affective disorders is a placebo. It is difficult because placebo control is associated with special difficulties.: what and how to do in the control. That is probably why placebo control was not used in most studies. In cases where control difficulties were overcome, a significant advantage of light over placebo was established. A positive placebo effect was also observed in patients with manic states. Source: Lapin I. P. “Placebo and therapy” Photo: odysseyonline-img.rbl.ms