Why do some people get better with just lots of love, fresh air and a sugar pill—at least for a while?

As this ScienCentral News video reports, neuroscientists say finding the answer could help make real medicine more effective.

Power of the Placebo

It’s just a sugar pill. It has no active medicinal content, and yet sometimes patients get well after taking it. In scientific communities it’s known as a placebo. Its power has puzzled scientists and baffled pharmaceutical industries for a long time. The improvements that patients experience from taking placebos is known as the placebo effect.

Placebos are commonly used in clinical tests of new drugs. Andrew Leuchter, professor of psychiatry at the University of California Los Angeles’s Neuropsychiatry Institute, says that when doctors test a new medical treatment or when pharmaceutical companies develop a new medication, “they always end up comparing it to a placebo, so they can see if this new medication that they’re developing is better than no treatment.” The placebo effect is so strong that new medications are generally not considered to be effective unless they are proven to work better than placebos.

Although scientists are not sure about how the placebo works, recent studies have illustrated that it’s power is hard to deny. Leucher and his colleagues witnessed and studied the placebo effect in patients being treated for major depression. In a study published in the American Journal of Psychiatry, the researchers explain that by using a technique called quantitative electro encephalography or QEEG, they measured and studied patient’s brain activity and showed for the first time that the placebo effect is not just in the mind but that it’s a real change, a real “physical phenomenon” in the brain.

Antidepressants vs. Placebos

The goal of their study was to find out how early they could detect changes in brain function with antidepressant treatment. They assigned 51 patients to either active medication or to placebos. The patients did not know which group they were assigned to until after the study was completed. Then researchers at the QEEG laboratory, periodically measured patients’ brain activity.

“With antidepressants, if a patient was going to get better somewhere down the road, we could see changes in brain function as early as 48 hours” after treatment began, according to Leuchter. They saw a suppression of activity in the prefrontal cortex of the brain, the area just behind the forehead. The researchers also found, quite unexpectedly, that the patients who were on the placebo showed a change in brain activity in the same area of the brain. However, these patients showed an increase in brain activity and also the changes came on much later, after about two weeks. “So,” Leuchter points out, “it was a difference both in direction of change and the time course of change”.

Positive Expectations

“The million dollar question,” Leuchter says, “is why the placebo helps patients get better.” He thinks the reason lies not in the pill but in the patients themselves. He explains, “They go through the ritual of getting assessed, getting evaluated, and then finally at the end of it all they get a capsule. It could be a white pill or a blue pill. Whatever color it is, they have a strong expectation built up that they are going to get help—that they are going to get better. And we believe that both those things wrapped up together are what count for the placebo effect.”

Leuchter warns that placebos cannot be substitutes for actual, bona fide medical treatments. He says that even though some patients feel better on the placebo, “it’s a short-lived response. It’s not nearly as robust. It doesn’t have the staying power that medication has.”

But there are also very important lessons to be learned from the placebo effect. Leuchter quotes an example of how the placebo effect can be harnessed to help all patients get better on real medication. “So I’ve got an antidepressant for the treatment of depression but I know [from studying the placebo effect] that if a patient believes that that pill is going to help them then that pill is going to be effective,” he says. So he says he may work with the patient on their expectations, before he gives them the antidepressant, and try to cultivate the positive expectation—the belief that the pill will help them. This, he says, could make the anti-depressant more effective.

The study was funded by the National Institute of Mental Health and the National Alliance for Research on Schizophrenia and Depression.