| Popis: |
Placebo effect is an inescapable element of nearly all treatment interventions used in health care. Nonetheless, some health conditions as well as some treatment interventions are more susceptible to its effects. In that sense, it has been repeatedly argued that a large portion of responses to various interventions used for the treatment of depressive disorder can be attributed to placebo effects. However, these portions vary significantly as expectations, formed around more or less subtle cues about care setting, change. Transcranial magnetic stimulation (hereinafter TMS) has some unique and rather distinct features when compared with other usual treatment interventions (as psychoactive medication, that is, antidepressants). The placebogenic effect TMS has been widely discussed, both in research and clinical context, however still without any kind of firm conclusions. Here we present a series of cases in which response to TMS was unusual and unexpected. We use these outlier cases to map out and disentangle possible specific and unspecific effects that total treatment setting in general and TMS in particular yielded. Further on, practical issues and challenges related to controlling the placebo effects in care settings are discussed. As placebo is inevitable, and we might add critical, part of treatment interventions within the realm of mental health, in care settings it should be carefully harvested, so that it serves our patients and us for better and not for the worse. |
