How Psychological Factors Affect Drugs

Whether it's the placebo effect or something else, matters of the mind can greatly impact how people respond to drugs  

Your state of mind can greatly impact how you respond to drugs

While the placebo effect gets most of the press, other psychological factors can impact how drugs work in studies compared to the real world

Drugs nearly always work differently in the real world than they did in studies, to the great chagrin and frustration of doctors, and the public, too.

It’s pretty easy to see some of the reasons for those discrepancies. One obvious reason why drugs don’t work nearly as well as in the studies is the great role that the placebo effect plays.

The Placebo Effect

The placebo effect occurs when you are taking something that has no known effectiveness but you believe that it’s an active drug, vitamin, herb or whatever. Then there’s a pretty good chance that inert stuff will do something positive for you — it will often have exactly the same effect as the active chemical that the non-placebo takers are getting. Unfortunately, in many studies, that placebo effect is often very hard to dissociate from the effects of the drug being assessed.

This seems to be especially true, I think, for drugs that affect the brain and neurological system, such as sleeping pills, antidepressants, painkillers and so on. That’s often why so many of these types of drugs work less well in the real world than they did in studies.

The Nocebo Effect

But that’s not all, folks. There’s also the “nocebo” effect, which occurs when a test subject expects a bad result from something he’s getting. The chances of that bad thing happening rise simply from having that negative expectation.

In other words, someone who expects a side effect or complication from a drug or therapy is more likely to experience that negative consequence than someone who doesn’t think either of those possibilities will happen.

The Lessebo Effect

But wait, we’re not done yet because according to research presented at the recent 17th International Congress of Parkinson’s Disease and Movement Disorders, there is yet another “cebo” effect that can disturb study results and confuse patients and doctors alike.

This one has been labelled the “lessebo” effect and, according to the lead Canadian researcher, Dr. Tiago Mestre, it means that a patient who goes into a study in which he is given a medication known to be effective (in this case, for Parkinson’s disease) doesn’t get as good a jolt from the medication simply because he knows there’s a placebo arm in the study — and he thinks he may be on the placebo and not on the drug.

The upshot is that some drugs may actually work better in the real world than in a study because in the real world, no one thinks they’re getting a placebo.

Dr. Art Hister is a medical writer and health analyst for Global TV.

Originally published in TVW. For daily programming updates and on-screen Entertainment news, subscribe to the free TVW e-newsletters, or purchase a subscription to the weekly magazine.