Genes[edit]
In social anxiety disorder (SAD) an inherited variant of the gene for tryptophan hydroxylase 2 (enzyme that synthesizes the neurotransmitter serotonin) is linked to reduced amygdala activity and greater susceptibility to the placebo effect.[112][113][114] The authors note "additional work is necessary to elucidate the generalizability of the findings".
In a 2012 study, variations on the COMT (catechol-O-methyltransferase) gene related to dopamine release are found to be critical in the placebo effect among the patients with irritable bowel syndrome participating in the trial, a research group in Harvard Medical School reported. Patients with a variation of met/met, for having two copies of the methionine allele were shown to be more likely to respond to the placebo treatment, while the variation of val/val, for their two copies of valine allele responded the least. The response of patients with one copy each of methionine and valine fell in the middle. Release of dopamine in patients with the met/met variations is thought to link to reward and 'confirmation bias' which enhance the sense that the treatment is working. The role of the COMT gene variations are expected to be more prominent in studies where patients report more subjective conditions such as pain and fatigue rather than objective physiological measurements.[115][116]
Symptoms and conditions[edit]
The placebo effect occurs more strongly in some conditions than others. Dylan Evans has suggested that placebos work most strongly upon conditions such as pain, swelling, stomach ulcers, depression, and anxiety that have been linked with activation of the acute-phase response.[117]
Pain[edit]
The placebo effect is believed to reduce pain—a phenomenon known as placebo analgesia—in two different ways. One way is by the placebo initiating the release of endorphins, which are natural pain killers produced by the brain.[118] The other way is the placebo changing the patient's perception of pain. "A person might reinterpret a sharp pain as uncomfortable tingling."[119]
One way in which the magnitude of placebo analgesia can be measured is by conducting "open/hidden" studies, in which some patients receive an analgesic and are informed that they will be receiving it (open), while others are administered the same drug without their knowledge (hidden). Such studies have found that analgesics are considerably more effective when the patient knows they are receiving them.[120]
When administered orally, placebos have clinically meaningful effects with regard to lower back pain.[121]
Depression[edit]
In 2008, a controversial meta-analysis led by psychologist Irving Kirsch, analyzing data from the FDA, concluded that 82% of the response to antidepressants was accounted for by placebos.[122] However, there are serious doubts about the used methods and the interpretation of the results, especially the use of 0.5 as cut-off point for the effect-size.[123] A complete reanalysis and recalculation based on the same FDA data discovered that the Kirsch study suffered from important flaws in the calculations. The authors concluded that although a large percentage of the placebo response was due to expectancy, this was not true for the active drug. Besides confirming drug effectiveness, they found that the drug effect was not related to depression severity.[124]