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Placebo TalksModern perspectives on placebos in society$
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Amir Raz and Cory Harris

Print publication date: 2015

Print ISBN-13: 9780199680702

Published to Oxford Scholarship Online: March 2016

DOI: 10.1093/acprof:oso/9780199680702.001.0001

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Active expectations: insights on the prescription of sub-therapeutic doses of antidepressants for depression

Active expectations: insights on the prescription of sub-therapeutic doses of antidepressants for depression

Chapter:
(p.33) Chapter 3 Active expectations: insights on the prescription of sub-therapeutic doses of antidepressants for depression
Source:
Placebo Talks
Author(s):

Veronica de Jong

Amir Raz

Publisher:
Oxford University Press
DOI:10.1093/acprof:oso/9780199680702.003.0003

This chapter sheds light on the hollows between active drugs and pure placebos in the context of a medical condition of rising global concern: depression. Drawing on the placebo antidepressant literature and interviews conducted with academic psychiatrists, this chapter explores the use, as well as the conceptualization of, below threshold (“sub-therapeutic”) doses as placebos. It appears that although psychiatrists do not report intentionally prescribing sub-therapeutic doses to elicit placebo effects, many forms of complex communication and expectation-shaping techniques relating to dose seem to permeate the use of such treatments. Through the investigation of intimate practice patterns and the current scientific literature, this chapter uncovers tacit professional attitudes and sketches conceptual challenges in the contemporary treatment of depression. It highlights how clinical practice would benefit from a greater appreciation among physicians and policy makers that at low, if not any, dose, antidepressants may be closer to active placebos than efficacious drugs.

Keywords:   placebo, sub-therapeutic, depression, antidepressant, psychiatrists, below threshold dose, active placebo

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