What if your patient’s skepticism is why the antidepressant isn’t working?
STUDY: Bonnet U, Clin Neuropharm 2026;00:000–000
STUDY TYPE: Case report
FUNDING: Independent
Background
The placebo is a well-known part of antidepressant response, but it’s opposite can also enter into the picture: the nocebo effect. This case report illustrates just how much that belief can matter.
The Study
A 47-year-old woman with severe melancholic depression spent months insisting her symptoms were medical, not psychiatric. She agreed — reluctantly — to venlafaxine ER, titrated to 300 mg/day. The med failed.
Later, four weekly educational sessions helped her accept her diagnosis and believe that venlafaxine could help. Restarted at 150 mg/day under this new mindset, it worked. She reached remission and has stayed there for over a year.
Was she having a placebo response? Not exactly. A prior course of psychotherapy hadn’t helped her depression either. More likely, the nocebo response was preventing the medication from working in the first trial. However, placebo response is not a all-or-nothing phenomena. For most patients, it is part of their response, just in varying degrees.
Limitation: Single case, spontaneous remission can’t be ruled out.
Practice Implications
- Sometimes it is unwise to have patients try medications when they don’t believe they can help, particularly in placebo (and noncebo) responsive disorders like depression and anxiety.
- Learn how to engage patients with treatment in our Carlat interview with Shawn Christopher Shea, or through his book, the Medication Interest Model.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
What’s Your Take? Share in Comments
- Have you seen patient’s beliefs shape their response to medication?
