The Nocebo Effect With Prescribed Drugs: Counterpart to Placebo Effect

Have you ever heard of the nocebo effect, the counterpart to the more widely known placebo effect?

Chris Berdik, a science journalist, explains this phenomenon in last year’s Mind Over Mind: The Surprising Power of Expectationsthough the book has a much broader scope than this one aspect. Mind Over Mind is about what happens when we anticipate and expect versus stay in the present. The “paradox of expectations,” as explained in the book description is that “(t)heir influence seems based on illusion, even trickery, but they can create their own reality, for good or for ill.”

Our minds set up outcomes, in other words, that wouldn’t have happened otherwise—self-fulfilling prophesies. Some can work to our advantage. For example, if a sugar pill fixes your headache because you thought you were actually taking the real thing, that’s the placebo effect.

Fearing your new pill will produce unwanted responses is another—and opposite—thing. And it’s explained by Berdik in a Boston Globe article: “When patients are warned of possible pain and unpleasant side effects, it increases the likelihood that they’ll experience them. If the placebo effect—in which positive patient expectations can be therapeutic—is relatively famous and well explored, the nocebo effect is its little-known evil twin…”

When taking prescribed drugs, then, the user’s experience of bad side effects may be partly from the drug itself—but partly not. Some of the negative responses may also be set up by our minds—from our own preconceived notions pre-pill-taking.

The Harvard Mental Health Letter indicates that people with certain conditions—anxiety, depression, and hypochondria—are more likely to fall prey to the nocebo effect. “It’s not clear why, but one theory is that these psychological states may cause somatization, the expression of emotional disturbances in the form of physical symptoms.”

Two researchers who analyzed the existing studies on the nocebo effect, Paul Enck and Winfried Häuser, cite (in The New York Times) an interesting example relevant to this post:

In one remarkable case, a participant in an antidepressant drug trial was given placebo tablets — and then swallowed 26 of them in a suicide attempt. Even though the tablets were harmless, the participant’s blood pressure dropped perilously low…

Chris Berdik’s article takes us to the logical and ultimate dilemma at hand: “Doctors and bioethicists are now seriously asking an unexpected question: whether, if the truth can literally hurt, it might sometimes be acceptable, or even in the patients’ interest, to hide the truth instead.”

How do you feel about this? Would you want, or have you ever wanted, to remain uninformed of the “possible side effects” of something you’re about to start taking?

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