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  • Faria, VandaUppsala universitet,Institutionen för psykologi,Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA,Uppsala University, Sweden; Harvard Medical Sch, MA USA (author)

Do You Believe It? Verbal Suggestions Influence the Clinical and Neural Effects of Escitalopram in Social Anxiety Disorder : A Randomized Trial

  • Article/chapterEnglish2017

Publisher, publication year, extent ...

  • Elsevier BV,2017
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:su-149176
  • https://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-149176URI
  • https://doi.org/10.1016/j.ebiom.2017.09.031DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:136970536URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-331755URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-143092URI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • The Swedish Research Council for Working Life and Social Research (grant 2011-1368), the Swedish Research Council (grant 421-2013-1366), Riksbankens Jubileumsfond – the Swedish Foundation for Humanities and Social Sciences (grant P13-1270:1).
  • Vanda Faria and Malin Gingnell contributed equally
  • Funding Agencies|Swedish Research Council for Working Life and Social Research; Swedish Research Council, Riksbankens Jubileumsfond; Swedish Foundation for Humanities and Social Sciences and International [437-2014-6767]
  • Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety, but their efficacy relative to placebo has been questioned. We aimed to test how manipulation of verbally induced expectancies, central for placebo, influences SSRI treatment outcome and brain activity in patients with social anxiety disorder (SAD).Methods: We did a randomized clinical trial, within an academic medical center (Uppsala, Sweden), of individuals fulfilling the DSM-IV criteria for SAD, recruited through media advertising. Participants were 18 years or older and randomized in blocks, through a computer-generated sequence by an independent party, to nine weeks of overt or covert treatment with escitalopram(20 mg daily). The overt group received correct treatment information whereas the covert group was treated deceptively with the SSRI described, by the psychiatrist, as active placebo. The treating psychiatrist was necessarily unmasked while the research staff was masked from intervention assignment. Treatment efficacy was assessed primarily with the self-rated Liebowitz Social Anxiety Scale (LSAS-SR), administered at week 0, 1, 3, 6 and 9, also yielding a dichotomous estimate of responder status (clinically significant improvement). Before and at the last week of treatment, brain activity during an emotional face-matching task was assessed with functional magnetic resonance imaging (fMRI) and during fMRI sessions, anticipatory speech anxiety was also assessed with the Spielberger State-Trait Anxiety Inventory - State version (STAI-S). Analyses included all randomized patients with outcome data at posttreatment. This study is registered at ISRCTN, number 98890605.Findings: Between March 17th 2014 and May 22nd 2015, 47 patients were recruited. One patient in the covert group dropped out after a few days of treatment and did not provide fMRI data, leaving 46 patients with complete outcome data. After nine weeks of treatment, overt (n = 24) as compared to covert (n = 22) SSRI administration yielded significantly better outcome on the LSAS-SR (adjusted difference 21.17, 95% CI 10.69–31.65, p < 0.0001) with more than three times higher response rate (50% vs. 14%; χ2(1) = 6.91, p = 0.009) and twice the effect size (d = 2.24 vs. d = 1.13) from pre-to posttreatment. There was no significant between-group difference on anticipatory speech anxiety (STAI-S), both groups improving with treatment. No serious adverse reactions were recorded. On fMRI outcomes, there was suggestive evidence for a differential neural response to treatment between groups in the posterior cingulate, superior temporal and inferior frontal gyri (all z thresholds exceeding 3.68, p ≤ 0.001). Reduced social anxiety with treatment correlated significantly with enhanced posterior cingulate (z threshold 3.24, p = 0.0006) and attenuated amygdala (z threshold 2.70, p = 0.003) activity.Interpretation: The clinical and neural effects of escitalopram were markedly influenced by verbal suggestions. This points to a pronounced placebo component in SSRI-treatment of SAD and favors a biopsychosocial over a biomedical explanatory model for SSRI efficacy.

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  • Gingnell, Malin,1982-Uppsala universitet,Institutionen för psykologi,Uppsala University, Sweden(Swepub:uu)malgi638 (author)
  • M. Hoppe, JohannaUppsala universitet,Institutionen för psykologi,Uppsala University, Sweden(Swepub:uu)johmo100 (author)
  • Hjorth, OlofUppsala universitet,Institutionen för psykologi,Uppsala University, Sweden(Swepub:uu)olohj176 (author)
  • Alaie, ImanUppsala universitet,Institutionen för psykologi,Barn- och ungdomspsykiatri,Uppsala University, Sweden(Swepub:uu)imaal559 (author)
  • Frick, AndreasUppsala universitet,Institutionen för psykologi,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Uppsala University, Sweden; Karolinska Institute, Sweden(Swepub:uu)andfr548 (author)
  • Hultberg, SaraUppsala universitet,Institutionen för psykologi,Uppsala University, Sweden (author)
  • Wahlstedt, KurtUppsala universitet,Institutionen för psykologi,Uppsala University, Sweden (author)
  • Engman, JonasUppsala universitet,Institutionen för psykologi,Uppsala University, Sweden(Swepub:uu)jonen754 (author)
  • Månsson, Kristoffer N. T.Uppsala universitet,Karolinska Institutet,Stockholms universitet,Klinisk psykologi,Uppsala University, Sweden; Karolinska Institute, Sweden; Stockholm University, Sweden,Institutionen för psykologi,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Department of Psychology, Stockholm University, Stockholm, Sweden(Swepub:uu)krima962 (author)
  • Carlbring, PerStockholms universitet,Klinisk psykologi,Department of Psychology, Stockholm University, Stockholm, Sweden(Swepub:su)pecar (author)
  • Andersson, GerhardLinköpings universitet,Karolinska Institutet,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Psykologi,Filosofiska fakulteten(Swepub:liu)geran87 (author)
  • Reis, MargaretaLinköpings universitet,Avdelningen för läkemedelsforskning,Medicinska fakulteten(Swepub:liu)marre53 (author)
  • Larsson, Elna-MarieUppsala universitet,Radiologi,Uppsala University, Sweden(Swepub:uu)elnla305 (author)
  • Fredrikson, MatsUppsala universitet,Karolinska Institutet,Institutionen för psykologi,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Uppsala University, Sweden; Karolinska Institute, Sweden(Swepub:uu)matsfred (author)
  • Furmark, TomasUppsala universitet,Institutionen för psykologi,Uppsala University, Sweden(Swepub:uu)tomafurm (author)
  • Uppsala universitetInstitutionen för psykologi (creator_code:org_t)

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  • In:EBioMedicine: Elsevier BV24, s. 179-1882352-3964

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