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Die Rolle von Placebo- und Nocebomechanismen bei depressiven Erkrankungen und ihrer Therapie

The role of placebo and nocebo mechanisms in depressive diseases and their treatment

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Zusammenfassung

Hintergrund

Bei der Therapie mit Antidepressiva scheinen viele Placebomechanismen und Noceboeffekte den Behandlungserfolg zu beeinflussen. Ein besseres Verständnis der diesen Effekten zugrunde liegenden Mechanismen ist notwendig, um Behandlungsverläufe zu optimieren und klinische Studien sensitiver zu machen.

Methoden

Placebo- und Nocebomechanismen wurden anhand empirischer Studien analysiert und die Ergebnisse in einem narrativen Review zusammengefasst.

Ergebnisse

Sowohl klinische Studien als auch experimentelle mechanismusorientierte Arbeiten unterstreichen die Auswirkungen von Placebo- und Nocebomechanismen bei der Behandlung mit Antidepressiva.

Diskussion

Durch eine effektive Nutzung von Placebomechanismen und Reduktion von Noceboeffekten können Behandlungserfolge beim Einsatz von Antidepressiva erhöht werden und die Wahrscheinlichkeit von Nebenwirkungen reduziert werden. Die Ergebnisse betonen den Einfluss von Interaktionen zwischen Kliniker und Patient, die Rolle des Behandlungskontextes und von Vorerfahrungen mit anderen Behandlungen des Patienten. Gleichzeitig stimulieren die Ergebnisse dieses Forschungsbereichs ein neues Verständnis psychischer Erkrankungen, hier insbesondere von Depressionen, und geben auch Anhaltspunkte zur Optimierung psychotherapeutischer Behandlungen.

Abstract

Background

There is substantial evidence that placebo and nocebo effects occur during treatment with antidepressants. A better understanding of the underlying mechanisms of these effects is necessary to optimize the outcome of treatment and to make clinical studies more sensitive.

Methods

Placebo and nocebo mechanisms were analyzed based on empirical studies and the results are summarized in a narrative review.

Results

Clinical studies and also experimental mechanism-oriented studies underline the effects of placebo and nocebo mechanisms in the treatment with antidepressants.

Conclusion

The success of treatment in the use of antidepressants can be increased and the probability of side effects can be reduced by the effective use of placebo mechanisms and reduction of nocebo effects. The results emphasize the influence of clinician-patient interactions, the role of the treatment context and previous experiences with other treatments of the patient. Simultaneously, the results of this research field stimulate a new understanding of mental disorders, in particular depression and also provide points of reference for optimization of psychotherapeutic treatment.

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Danksagung

Viele der in diese Arbeit eingeflossenen Impulse entstammen Studien und Diskussionen im Kontext der DFG-Forschergruppe 1328 (Sprecher: Prof. Rief) sowie dem SFB 289 (Sprecherin: Prof. Bingel). Allen beteiligten Wissenschaftlerinnen und Wissenschaftlern gilt mein besonderer Dank für die konstruktive Kooperation.

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  1. Psychotherapie Ambulanz, Philipps Universität Marburg, Gutenbergstraße 18, 35032, Marburg, Deutschland

    Winfried Rief

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W. Rief gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Rief, W. Die Rolle von Placebo- und Nocebomechanismen bei depressiven Erkrankungen und ihrer Therapie. Nervenarzt 91, 675–683 (2020). https://doi.org/10.1007/s00115-020-00940-x

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