Psychedelic Drugs And The Placebo Effect

The Placebo Effect.

Most people know what it is: a physician gives a patient a “sugar pill” (or some other inert substance) for a medical ailment rather than an actual drug, but the patient still reports an improvement in symptoms. Yet not many have looked at this phenomenon closely enough to really understand it.

Placebo “medicine” can take two forms.

The physician gives the patient a placebo, but does not tell the patient it is a placebo (i.e. the patient thinks they are receiving a real medicine).

The physician gives the patient a placebo and tells the patient up front that it is a placebo.

There can also be a Placebo Effect with actual medications. The medication does not actually generate a physiological improvement in the patient’s condition. Yet the patient still reports (and experiences) an improvement in symptoms.

Understanding Placebo Medicine and the Placebo Effect

Here is the first aspect of Placebo Medicine that will be a surprise to most readers. Both (1) and (2) can produce reported improvements from patients. For certain conditions, even if the patient knows they are receiving an inert substance the patient will still report an improvement in symptoms.

How can this be possible? The human mind is a very powerful organ, capable of having a physiological impact on the body.

Some medical conditions are especially pernicious. They produce intense, chronic symptoms for sufferers and medical science doesn’t yet have an effective therapy to provide treatment.

Tell those people that you are giving them a placebo and some of them will report a reduction in their symptoms.

For some, it is empowering: feeling like they are “doing something” (no matter how trivial) to address their condition. For others, it is merely offering them some hope.

If the Placebo Effect can produce measurable benefits even in the absence of any deceit, obviously it is an even more potent tool for patients who do not know they are receiving a placebo.

The Placebo Effect in mental health therapy

Not surprisingly, the Placebo Effect is especially prevalent when it comes to treating mental health disorders. For many of these conditions, a major factor in the condition is the patient’s own subjective appraisal of how they are feeling.

A physician hands a patient a pill and tells the patient “this might make you feel better.” For a certain percentage of the population, the power of suggestion alone will have an effect. We can be influenced by what others say to us.

For still more people, they will internally generate a positive benefit from the placebo due to (as mentioned) feeling empowered and/or more hopeful.

In North America (and much of the West), mainstream medicine still largely shuns Placebo Medicine. Only about 1 in 8 physicians in a UK survey acknowledged ever using placebos with their patients.

Officially, medical associations (like the AMA) severely restrict the use of placebos. Specifically, the American Medical Association only authorizes the use of a placebo if the patient is told they are receiving a placebo.

As previously noted, this dramatically limits the scope and effectiveness of placebos to (primarily) only particularly pernicious disorders.

Germany, on the other hand, practices true Placebo Medicine: doctors “prescribing” placebos to patients without explicitly telling the patient they are receiving an inert substance.

Naturally, this has greatly expanded the scope and effectiveness of Placebo Medicine in Germany. Over half of all German doctors have prescribed placebos.

Placebo Medicine is not medical quackery. Rather, it is a safe and known tool that can provide relief to a significant percentage of patients without the risk of drug dependencies or other unwanted side effects.

Placebo Medicine and psychedelic drugs

Vigilant readers will have seen two themes in the media regarding the usefulness of psychedelic drugs in the treatment of mental health disorders.

The majority of media coverage has merely reported the (spectacular) treatment results emerging from most clinical studies involving psychiatric drugs. More recently, however, we have seen media coverage looking at “the Placebo Effect” with psychedelic drugs.
 
Those articles focused explicitly on microdosing of LSD. However, in clinical studies of psychedelic drugs at “experiential” dosages, the Placebo Effect is also observed in the control group – as it is with all drug testing.

Even if additional research determines that much/most of the benefit from psychedelics-based therapies is ‘merely’ the Placebo Effect, this is not a criticism of psychedelic medicine.

This is especially true with psychedelics like psilocybin and LSD, which have particularly benign safety profiles. If patients can be safely prescribed medications like psilocybin and LSD, and 25% or 50% or even 75% of the reported benefits are just a Placebo Effect, who cares?

Obviously, it is an infinitely superior strategy for a physician to safely prescribe LSD or psilocybin for a mental health disorder (drugs that are demonstrating very high efficacies in clinical studies) rather than prescribing a dangerous-and-addictive antidepressant.

Roughly 1/3rd of the ‘benefit’ from antidepressants is known to be purely a Placebo Effect. But antidepressants are only effective with roughly half of patients.

They rarely produce short-term cures. Thus, patients are often put on antidepressants for long periods of time – addicting them to these drugs and exposing patients to a long list of unpleasant (and even dangerous) side effects.

Today, more than 1 in 8 Americans above age 12 are currently being prescribed antidepressants. Doctors particularly like prescribing antidepressants to their female patients. A NY Times article reported that women are twice as likely as men to use antidepressants – and are much more likely to become addicted to them through long-term usage.
 
Over 25 million Americans have been taking antidepressants for two years or longer (as of 2018) and “many people taking antidepressants discover they cannot quit”.

The future of psychedelics medicine

“Placebo” is not a dirty word in psychedelic medicine, especially given that the alternative (in many cases) will be a dangerous-and-addictive antidepressant.

In fact, the high efficacy of psychedelic drugs in clinical studies ensures there will be a strong Placebo Effect. Think about it.

Your doctor prescribes psilocybin to you for your chronic depression (some time in the hypothetical future). Let’s make up a number and say that by this time, psilocybin is found to be effective in treating depression for 85% of patients. That’s not far off the success rate being reported in some studies.

You expect to feel better. Thus, you are more likely to simply convince yourself you are “better” via a Placebo Effect.

Contrast this with a physician prescribing the same patient an antidepressant, with a known efficacy of only ~50%. The patient will be much less confident in the treatment, and thus much less likely to either obtain a medicinal benefit or generate a Placebo Effect.

The Psychedelics Revolution shows the clear potential to transform mental health care – for the better. If (in hindsight) we discover that a significant factor in this Revolution is a Placebo Effect, this does not detract from either the medical or commercial potential of this emerging industry.

The world is currently suffering from a Mental Health Crisis. Roughly 1 in 6 people across the planet suffer from stress-related disorders like depression, anxiety, substance abuse and PTSD.

It has become a “crisis” because mainstream medicine has failed badly in providing adequate treatment options.

Roughly 2 out of 3 Americans exhibiting symptoms of depression don’t even seek treatment. Treatment for U.S. veterans suffering from PTSD from the Department of Veterans Affairs is ineffective for two-thirds of veterans.

Addiction "therapy" for many substance abusers is little more than a revolving door. Rehabilitate, release, relapse, repeat.

Clinical studies are showing that psychedelic drugs can be effective medicines for the vast majority of people undergoing therapies for these conditions (and many others). Additional patients will indirectly benefit from psychedelics purely from a Placebo Effect.

And there is nothing wrong with that.