SSRI antidepressant effectiveness may be impacted by verbal suggestions

A new study, conducted by Sweden researchers at Uppsala University, has brought the effectiveness of selective serotonin reuptake inhibitors (SSRIs) into a debate once again.

According to researchers, the effectiveness of SSRI treatments — commonly used to treat depressive and anxiety disorders — might be significantly influenced by the patient’s expectations.

The study, published in EBioMedicine, examined how verbal instructions influences SSRI antidepressant efficacy in patients with social anxiety disorder (SAD).

Researchers initiated a randomized clinical trial for participants who met the criteria for SAD, all of which were 18 years of age or older. After being split up in randomized blocks by a computer-generated sequence, participants received nine weeks of overt or covert treatment with 20 mg of Lexapro (escitalopram) a day.

The overt group was given accurate treatment information, whereas the treating psychiatrist deceptively described the SSRI treatment plan for the covert group. The self-rated Liebowitz Social Anxiety Scale (LSAS-SR), was given to participants at week 0, 1, 3, 6 and 9 to test the treatment’s effectiveness.  functional magnetic resonance imaging (fMRI) and during fMRI

The self-rated Liebowitz Social Anxiety Scale (LSAS-SR), was given to participants at week 0, 1, 3, 6 and 9 to test the treatment’s effectiveness. Functional magnetic resonance imaging (fMRI) was also used to assess brain activity.

The findings demonstrated that the number of participants who responded well to treatment was three times higher when correct information was given to them, despite all receiving the same treatment.

Furthermore, neuroimaging found changes in brain activity associated with expectations of improvement in both groups, specifically in the posterior cingulate cortex and the amygdala.

“This may reflect an interaction between cognition and emotion as the brain changes differently with medication pending on the patient’s expectancies,” said Malin Gingnell, co-author of the study.

The results shouldn’t undermine the effectiveness of SSRIs for anxiety. Instead, it should prove that the presentation of a treatment plan may be as important as the treatment itself, as Professor Tomas Furmark, the lead researcher, concluded.

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