The Nocebo Effect: why medications may not help or even harm

What is the nocebo effect?

This is when a harmless treatment causes a person’s condition to worsen. The nocebo effect can work if the patient believes the therapy is dangerous.

For example, in the United States, a 26-year-old man who was undergoing experimental psychotherapy took 29 capsules of prescription antidepressant after an argument with his girlfriend. The young man’s heart rate and blood pressure dropped, and he found himself semi-conscious. The paramedics took emergency measures to stabilize the patient’s condition. However, almost immediately it turned out that the pills were duds, given out as part of an experiment. Upon learning of this, the man quickly regained consciousness.

What causes the nocebo effect?

Our thoughts can strongly influence the way we feel. For example, fear of pain only intensifies it. That is, the brain is able to create false sensations that we cannot distinguish from the real ones. Therefore, negative expectations are considered one of the main causes of nocebo.

They can be influenced by a variety of factors, from how confident the doctor is, to the color and price of the pills.

According to one theory, the nocebo effect is related to the hormone cholecystokinin. It is produced in the intestines, is responsible for the feeling of satiety, and can also cause anxiety, restlessness, and hallucinations. Italian scientists found in 1997 that taking drugs that block cholecystokinin reduces nocebo-induced pain.

The work of Italian colleagues was continued by American scientists. Analyzing MRI data from the brains of people who experienced pain, the researchers concluded that the nocebo effect is observed in the activity of the hippocampus. This region of the brain, which is associated with anxiety and corticoid hormones, is stimulated by negative expectations of the person.

Who is most susceptible to the nocebo effect

There are several groups of people who may experience nocebo more often than others.

People prone to anxiety and depression
Doctors in Switzerland analyzed 407 scientific papers on nocebo from 1997 to 2018 and concluded that increased anxiety can exacerbate the effect. Also, susceptibility to nocebo is increased by depression and a tendency to think negatively.

People with chronic illnesses.
People with chronic pain as well as itchy skin conditions may be more susceptible to the effects. Such problems become constant factors of stress and discomfort. As a result, the person is always anxious and expects to feel worse.

Those who have had experiences with unsuccessful treatments
For example, if the therapy was chosen incorrectly or the doctor behaved unethically. During treatment, such people may have felt pain or discomfort and then involuntarily projected their fears onto any medical intervention.

What are the dangers of the nocebo effect

For several reasons at once.

Causes psychosomatic reactions.
For example, the belief in the harm of the drug leads to the fact that the person really feels the negative effects. In 2015, scientists conducted an experiment that confirms this thesis. Two groups of volunteers were injected with saline and a compound that caused an allergic reaction. Those who were sure they had received an allergen experienced itching, even though the doctors actually gave them a blank.

Makes one feel more acute pain and side effects
Because of nocebo, a person may be susceptible to side effects, even if there is no reason for it, and feel pain more acutely.

For example, people who took placebo rather than medication for migraine experienced the same adverse events as when taking the real medication. For example, decreased blood pressure and increased heart rate. And anorexia and memory problems were recorded only in those who took placebo drugs. All because the possibility of such problems had been reported before the experiments.

Transmitted from person to person
In November 1998, a schoolteacher from Tennessee smelled gasoline in her classroom. The woman soon became ill: she suffered from headaches, shortness of breath, and dizziness. More than a hundred students and staff sought medical attention after the teacher, and 38 were even hospitalized.

Subsequent investigations revealed no trace of poisoning either in the school or in the tests of the victims. It turned out that most of the people who complained about feeling unwell were those who had seen the “sick” or heard that there was a strange odor in the school. This case was called an example of mass psychogenic illness.

How to cope with the nocebo effect

Most of the research makes recommendations on how to overcome nochebo for doctors, but there are some things you can do yourself.

Check if you are at risk
First, you need to determine how susceptible you are to the nocebo effect. Tendency to anxiety and depression, negative treatment experiences, negative attitudes and skepticism are the most typical signs.

Don’t forget the dangers of self-hypnosis
The appearance of unmotivated side effects can easily be avoided by simply warning yourself that such effects may be caused by nocebo. After all, it is often self-influence that leads to a negative outcome.

Think more positively
It’s worth focusing on the positive, not the negative, effects of medications. In other words, the fact that the vast majority of people treatment helps, more important than the occurrence of side effects in 5% of patients.

The likelihood of being among the few people who have problems is extremely small, but our brains cling to that thought and it only hurts that way. So it’s worth trying to look at everything optimistically.

Find a good doctor
If you are treated by a real specialist, it is likely that you will trust him and will not doubt his methods. It’s also important that the doctor is tactful and takes a personalized approach. Especially if the patient is prone to anxiety.

Be proactive.
Talk to the doctor more often about how your treatment is going. This will give a sense of control and reduce the degree of distrust. Here again, the doctor’s professional and human ethics are important and he should be sympathetic to your questions and clarifications.

See a psychotherapist
If nocebo is caused by a negative experience of past treatment, psychotherapy can help.