Nonspecific medication side effects
and the nocebo phenomenon

by
Barsky AJ, Saintfort R, Rogers MP, Borus JF.
Department of Psychiatry,
Brigham and Women's Hospital,
75 Francis St, Boston, MA 02115, USA.
JAMA. 2002 Feb 6;287(5):622-7


ABSTRACT

Patients taking active medications frequently experience adverse, nonspecific side effects that are not a direct result of the specific pharmacological action of the drug. Although this phenomenon is common, distressing, and costly, it is rarely studied and poorly understood. The nocebo phenomenon, in which placebos produce adverse side effects, offers some insight into nonspecific side effect reporting. We performed a focused review of the literature, which identified several factors that appear to be associated with the nocebo phenomenon and/or reporting of nonspecific side effects while taking active medication: the patient's expectations of adverse effects at the outset of treatment; a process of conditioning in which the patient learns from prior experiences to associate medication-taking with somatic symptoms; certain psychological characteristics such as anxiety, depression, and the tendency to somatize; and situational and contextual factors. Physicians and other health care personnel can attempt to ameliorate nonspecific side effects to active medications by identifying in advance those patients most at risk for developing them and by using a collaborative relationship with the patient to explain and help the patient to understand and tolerate these bothersome but nonharmful symptoms.
TCAs
SSRIs
RIMAs
Options
Placebos
Bupropion
Amineptine
Reboxetine
Nefazodone
Mirtazapine
Venlafaxine
21st century
Antidepressants
Tranylcypromine
Atypical depression
Retarded depression
The monoamine hypothesis
Scepticism about antidepressants
Placebo treatment versus no treatment
Are SSRI antidepressants little better than placebos?
The placebo vs nocebo effect: opioid and dopaminergic substrates


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