It seems that a connection does indeed exist between the placebo effect and anxiety. Generalized anxiety disorder has symptoms that might stem from biological causes as well as emotional causes. Drugs such as benzodiazepines act on the various biological systems (such as serotonin systems) believed to be involved in depression. But what about the emotional aspect? It makes one wonder if changes in the biological systems in the brain are responsible for changes in the emotions that accompany it or if these emotional changes cause the biological changes. One cannot be sure of the direction of causality, but placebos, like actual medications, have been shown to act as anxiolytics.
There is no certainty about how placebos might act to reduce anxiety, but what is certain is that if placebos act on serotonergic systems to reduce anxiety, then it is the power of suggestibility that has its effects in relieving this disorder. Therefore, in one way or another, placebos affect one's physiological system and in anxiety have been shown to influence the emotions that are related to malfunctioning serotonergic systems.
So since the path of placebo action, specifically in serotonin-related symptoms, has not been clearly defined, localized or even molecularly detected as a distinct process, one can only assume the way it develops. The most relevant assumption to make, based on empirical information, is that the placebo action works similarly to a drug. By this it is meant that the plausible ways in which placebo action affects a given neural process are those in which it has been observed that drugs do. As a short reminder, this would imply that placebo action is occurring at one of the following levels: reuptake, synthesis, receptor binding, or vesicle content.
In other words, at the molecular level the brain must be acting on itself, affecting the serotonergic system directly. It should be noted that no one chemical or physical entity has been identified that "enacts" this placebo effect. There is obviously a clear connection between a cognitive process and a biochemical one, yet the identity or form of this connection remains unclear. In this project, the placebo effect and its characteristics have been described. Also, the data has shown that a placebo effect can be relevant when compared to a pharmacological effect. We are left with no option but to attribute the placebo effect, in anxiety, to a re-establishment of balance, if such terminology does not fall into the realm of the pseudo-psychological. Our neuroscientific thought pushes us to seek a better, more palpable explanation and the future will tell.
The effects of placebo action, however, are real and ineludible. The implications of such a poorly understood process are important. Our society has certainly become drug intensive and dependent while scientific study has shown in some cases, such as generalized anxiety disorder, that the body has great capabilities of self-regulation and maintenance. This again, brings out many issues. It may, on one hand, suggest that many disorders from which a growing number of people suffer may be anthropogenic. After all, if the body has an inherent capacity to remain stable and functional, there must be great stress pushing the brain out of balance. On the other hand, and leaving blame out of it, the mere presence of a placebo assumed to have an unknown biological identity may be controlled by chemical or cognitive means. This would imply an increased number of options for treatment in many areas that today are limited. Further study of the placebo effect in and beyond anxiety disorders shall reveal how we may use our ability for efficient and reliable cures.
Many studies have centered around the testing of drugs in the treatment of affective disorders such as generalized anxiety disorder and depression. These has involved human test subjects and subjective tests that attempt to quantify the patient's level of anxiety or depression. For instance, the Hamilton Depression Rating Scale requires patients to fill out a survey of questions that rates the relative incidence or severity of depression and anxiety symptoms on a numeric scale. There are also doctor patient interviews. It is difficult to look at bio-molecular changes that take place following drug treatment in live human subjects. We are forced to use these subjective tests. For these reasons, drug testing is particularly susceptible to the various forms of the placebo effect. Patient expectancy plays a large role. If a patient expects to feel improvement, he or she might actually misinterpret his/herself as having improved or make biased errors in assessing their feelings for the better. In some cases they might really think that they did improve significantly. And if they think they improved, isn't that necessarily an improvement? What is the criteria for a diagnosis of improvement? These are rather circular arguments that need to be considered carefully.
Also some patients might lie on these surveys or tests because they do not want to disappoint the researcher - saying that they improved when in fact they have not. The behavior and treatment of the subject by the researcher can influence this. There are also cases where patients will lie in order to receive more of a drug or treatment (i.e saying that they didn't improve in order to receive more drug testing). These types of placebo effects must be taken into consideration in any sort of data or study that deals with anxiety disorders and depression. The disorders that our project has covered are the most (as mentioned earlier) susceptible to these and other placebo effects. This means that one can not analyze findings related to anxiety disorders and depression and how serotonin mediates these disorders without looking at the placebo effect and using it as a control in related studies. That is why the placebo effect had to be discussed in relation to depression and generalized anxiety disorder.
The severity of the patient's disorder is a key factor in determining their response or non-response to a placebo. In the few studies that have been done, it seems that those sufferers who have the most severe symptoms are, unfortunately, least likely to respond. Those who have help-seeking behavior, a positive attitude towards therapy and an open mind about new treatments appear to respond the best to placebos. Could it be that the most drastic cases have a sort of locked circuit of anxiety that is not easily altered, whereas those who are more susceptible to influence have circuits that are more easily diverted? If we knew exactly how placebos acted on serotonergic circuits, we might have more clear answers, but for now we can only infer that an open mind is crucial for effective placebos.
Just as essential is an open mind in researching and evaluating these amazing placebo effects. In our society, we are often quick to feed the body a chemical when we detect an imbalance or upset. A quick and easy fix is most desirable and generally embodied in our perception of medication. As we have demonstrated, however, the 'power of the mind' can be just as effective in returning the much needed balance and happiness. And wouldn't it be better in the long run to be able to re-direct those circuits that have gone awry, or otherwise make those natural, physical corrections in the brain rather than simply act on them with a drug? This is merely one of the questions we are left pondering after our exploration into the power of placebo. Drug therapy has been proven to work wonders, and we don't know if the placebo does indeed cause a re-wiring or correction. We are not to say whether any therapy is superior over another, but we can say that placebo therapy is a good idea. We don't know all that we don't know, and without creativity in research, we never will.