4 - Placebo and Nocebo Effects

Summary

If the placebo effect is not the bane of every psychopharmacologist’s existence, it probably should be. Placebo responses largely negate all rules of pharmacodynamics, undermine theories about drug mechanisms of action, ruin clinical trials by causing failed (rather than negative) findings that mask the true potential for otherwise promising compounds, inflate costs for drug research and development, and generally give a black eye to neuroscience-based explanations for psychopathology. They also lend humility to clinicians’ assumptions that psychopharmacology reliably holds the upper hand when dealing with any and all matters of mental illness. In this chapter we will review known clinical features and correlates (if not actual predictors) of placebo responsivity across major psychiatric conditions, and offer guidance about how clinicians can anticipate, recognize and manage placebo effects – rather than ignore, dismiss, or otherwise struggle against them.