The role of expectancy in recovery

The following message was removed from http://www.schizophrenia.com:8080/jiveforums/forum.jspa?forumID=10:

Now it has been shown that antidepressants are pure placebo, we can wonder if antipsychotics are more than the expectancy off recovery1,2.
A placebo effect doesn’t mean that the treatment has no effect. Kirsch (2009) shows that placebo is much more effective than waiting list in treating depression.
In a meta-analysis, which also contained unpublished pharmaceutical industry sponsors trials, antidepressants were not ‘clinically significantly’ more effective than placebo. In experiments in which a placebo with side effects was used, there was no difference between antidepressant and placebo3.
In experiments it is required that participants are said that they can get a placebo or a drug and they are informed about the possible side effects. They and their physicians naturally ask themselves in which condition they are. If they perceive side-effects they believe they got the drugs so the experience a full placebo effect. If they believe to be in the placebo condition, because of lack of side effects, they experience a diminished placebo effect. So depression is now treatable without side effects. The exact form is subject to discussion.

Does this possibility also exist for schizophrenia?
A recent meta-analysis of published experiments comparing second generation antipsychotics with placebo found a small difference in response rate: 24% responded to placebo, 41% to the drug4. Disclosure/Conflict of interest shows that the writer of the meta-analysis had in the past received money from drug companies.
You can wonder what had happened if also the trials the drug companies are trying to hide were included in the meta analysis (as Kirsch has done for depression).
What would happen if antipsychotics are compared to an active placebo? Comparing antipsychotics with a non antipsychotic drug is not often done and has given conflicting results5.
There is a strange phenomenon that when two atypical antipsychotics are compared with each other, the drug of the company sponsoring the trial compares better than the drug of the competitor6.
A curious phenomenon is recently going on in drug trials with antipsychotics. At the same time as people were saying that new antipsychotics had less side effects, the placebo response is going up, so that in recent trials they don’t find a difference between drug and placebo also when they include an old drug beside placebo and a new drug7,8. Although drug companies7,8 see it as a problem with the experiments, it is very well possible that nowadays physicians and schizophrenics expect less side effects so that they are more willing to believe that someone receiving placebo is getting the real drug so that they experience a full placebo effect.
So maybe you can get rid of the side effects with a little bit of positive thinking. You think what you think you will think and you do what is expected of you9.

References:
1. http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/
2. http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/
3. Kirsch (2009).The Emperor’s New Drugs: Exploding the Antidepressant Myth.
4. http://www.nature.com/mp/journal/v14/n4/abs/4002136a.html
5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3230235/
6. http://www.psychservices.psychiatryonline.org/article.aspx?articleid=178035&RelatedWidgetArticles=true
7. http://schizophreniabulletin.oxfordjournals.org/content/36/3/504.short
8. http://www.cybermed.it/cybermedpdf/Placebo%20Response%20In%20Clinical%20Trials%20With%20Schizophrenia%20Patients.pdf
9. http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect

there is such thing as breif psychotic disorders yet this isn;t diagnosed coz they think the drugs are responsible....I've recovered through learning chigong and breathwork like taoist internal arts that heal the mind/body and spirit yet this is considered that I am deluded....hey some psychotics will recover after a few nights rest but that hasn;t come into their little minds at possibly identifying where antipsychotics are useless....

IO guess one way if they could rig it is that they would say it wasn;t schizophrenia afterall and get them out of the trials if they suspected they on placebo....I wonder how much any double blind study would alter the perceptions of the doctor to manipulate results if they could tell the difference with side effects and whether they got active substance, certainly you get sedation with antipsychotic trials maybe any substance that is sedative will seem like a recovery to get over stressfull period, unfortunately none of them are getting help with real issues , that can only be done through our own means of self-therapy or learning to seek wisdom and mastery over life, you can;t do that on an antipsychotic

interesting about the placebo response getting higher and maybe I hope there is a way to prove that elly-lilly drug to be as good as a competing drug, but they lack sedation and side-effects anyway, the typical pacive haze of antipsychotic is illusive of recovery.

It should be possible to develop a drug with only harmless side effect to make it possible for patients to detect that they are in the drug condition.

A certain percentage of people can detect that they have eaten asparagus from the smell of their urine. One investigation spoke of 43 % of volunteers producing odorous urine after ingesting asparagus. It is said that eating asparagus is totally harmless. Something like the active ingredient of asparagus could be added to an inactive substance to make a harmless drug detectable by patients.

(Other drug indicators could be only detectable by laboratory investigation. This way it is maybe possible to differentiate patient and doctor in the placebo effect.)

A drug company can then prove it superior to placebo and bring it on the market in the usual way.

They only need to add a non-placebo effect explanation of why it is effective.

Information about Asparagus effect on urine:
http://nutrition.about.com/od/changeyourdiet/f/Why-Does-Eating-Asparagus-Make-Urine-Smell-Bad.htm
http://www.whfoods.com/genpage.php?tname=foodspice&dbid=12
http://diyhpl.us/~bryan/papers2/bio/Odorous%20urine%20following%20asparagus%20ingestion%20in%20man.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1379935/
http://resources.betterfly.com/uploads_resources/61000/60340/1299657347-6451.pdf

All I can say for sure is that it is impossible to recover, with or without medications, unless there is an expectation that recovery will happen. I don't know about schizophrenia, but I do know about bipolar disorder. It can be beaten, and I believe the meds can help buy enough time to get on top of things. It's a pain in the ass to recover, but it is very doable. I wish the docs would report that fact. All I can say about the docs in such a case is "Idiots!" (followed by a feeble kick in the air in Napoleon Dynamite fashion)...

By the way, as an academic person myself (research engineer at a laboratory), I can safely say that the research in the literature is many years behind what is actually known to cutting edge research.

Hard to understand why that would be removed from those forums. It's not like anything you wrote is a big secret. What the hell is wrong with some people? They're like nazis except with inferior dress code.

Really, little if any of that is news these days. The psychiatrists know it. The researchers know it. The drug companies know it. They're just not doing anything about it, each for reasons typical of their caste I suppose.

I've personally seen a run-of-the-mill psychiatrist admit there's significant publication bias regarding the efficacy of antidepressants, and then instantly recover from that like from a bad dream and continue as if that fact meant nothing outside the limited context of the efficacy of antidepressants. I mean, geez, you just admitted the information psychiatrists have been getting for the past thirty years has been utterly corrupted by bias, and you wouldn't even have suspected you've received incorrect information if someone hadn't made a FOIA request and produced a meta analysis that included the uncovered studies, previously hidden from the public.

It's like you'd hit a random beam in a rotten house, and it'd spill open with termites, you'd just say, "Hey, I suppose we must replace that beam. That's all it takes." Yeah, that's all it means. Ugh...