Do You Believe It? Verbal Suggestions Influence the Clinical and Neural Effects of Escitalopram in Social Anxiety Disorder: A Randomized Trial
| العنوان: | Do You Believe It? Verbal Suggestions Influence the Clinical and Neural Effects of Escitalopram in Social Anxiety Disorder: A Randomized Trial |
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| المؤلفون: | Malin Gingnell, Olof Hjorth, Margareta Reis, Tomas Furmark, Johanna M. Hoppe, Gerhard Andersson, Jonas Engman, Kristoffer N.T. Månsson, Elna-Marie Larsson, Sara Hultberg, Iman Alaie, Kurt Wahlstedt, Vanda Faria, Per Carlbring, Andreas Frick, Mats Fredrikson |
| المصدر: | EBioMedicine EBioMedicine, Vol 24, Iss C, Pp 179-188 (2017) |
| بيانات النشر: | Elsevier, 2017. |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | Male, General Practice, lcsh:Medicine, Severity of Illness Index, law.invention, Random Allocation, 0302 clinical medicine, Randomized controlled trial, law, Medicine, Psychology, SSRI, Suggestion, Social anxiety disorder, Depression (differential diagnoses), lcsh:R5-920, digestive, oral, and skin physiology, Social anxiety, fMRI, General Medicine, Serotonin reuptake, Amygdala, Magnetic Resonance Imaging, Antidepressive Agents, Expectancies, Treatment Outcome, Anxiety, Female, medicine.symptom, lcsh:Medicine (General), Selective Serotonin Reuptake Inhibitors, medicine.drug, Research Paper, Adult, medicine.medical_specialty, Neuroimaging, Citalopram, Placebo, Gyrus Cinguli, behavioral disciplines and activities, General Biochemistry, Genetics and Molecular Biology, Drug Administration Schedule, 03 medical and health sciences, Young Adult, mental disorders, Escitalopram, Humans, Psychiatry, Depressive Disorder, Major, Psykologi, Placebo effect, business.industry, lcsh:R, Phobia, Social, 030227 psychiatry, Allmänmedicin, Commentary, business, 030217 neurology & neurosurgery |
| الوصف: | Background Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety, but their efficacy relative to placebo has been questioned. We aimed to test how manipulation of verbally induced expectancies, central for placebo, influences SSRI treatment outcome and brain activity in patients with social anxiety disorder (SAD). Methods We did a randomized clinical trial, within an academic medical center (Uppsala, Sweden), of individuals fulfilling the DSM-IV criteria for SAD, recruited through media advertising. Participants were 18 years or older and randomized in blocks, through a computer-generated sequence by an independent party, to nine weeks of overt or covert treatment with escitalopram (20 mg daily). The overt group received correct treatment information whereas the covert group was treated deceptively with the SSRI described, by the psychiatrist, as active placebo. The treating psychiatrist was necessarily unmasked while the research staff was masked from intervention assignment. Treatment efficacy was assessed primarily with the self-rated Liebowitz Social Anxiety Scale (LSAS-SR), administered at week 0, 1, 3, 6 and 9, also yielding a dichotomous estimate of responder status (clinically significant improvement). Before and at the last week of treatment, brain activity during an emotional face-matching task was assessed with functional magnetic resonance imaging (fMRI) and during fMRI sessions, anticipatory speech anxiety was also assessed with the Spielberger State-Trait Anxiety Inventory - State version (STAI-S). Analyses included all randomized patients with outcome data at posttreatment. This study is registered at ISRCTN, number 98890605. Findings Between March 17th 2014 and May 22nd 2015, 47 patients were recruited. One patient in the covert group dropped out after a few days of treatment and did not provide fMRI data, leaving 46 patients with complete outcome data. After nine weeks of treatment, overt (n = 24) as compared to covert (n = 22) SSRI administration yielded significantly better outcome on the LSAS-SR (adjusted difference 21.17, 95% CI 10.69–31.65, p Highlights • Overt surpassed covert SSRI treatment with doubled effect size and tripled response rate on the main social anxiety outcome. • Overt vs. covert SSRI treatment yielded different neural changes in brain areas involved in emotion-cognition interactions. • This study suggests that the presentation of a treatment may be as important as the treatment itself. Using truthful or deceiving verbal instructions, we tested how expectancies influence SSRI efficacy in social anxiety disorder. The number of responders was more than three times higher after open administration of escitalopram 20 mg compared to covert administration of the drug presented as “active placebo” in a cover story. Correct vs. incorrect information about the SSRI also yielded different neural changes in brain areas involved in emotion-cognition interactions. The benefit of SSRI medication seems to be highly affected by psychological factors like positive expectancies traditionally associated with placebo. Our results favor a biopsychosocial over a biomedical explanatory model for SSRI efficacy. |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 2352-3964 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9303eaeb02253399a5d8497a32c07b14 http://europepmc.org/articles/PMC5652281 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....9303eaeb02253399a5d8497a32c07b14 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 23523964 |
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