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Sex, Drugs, and the Neurobiology of the Placebo Effect

  • David R. Rubinow
    Correspondence
    Address correspondence to David R. Rubinow, M.D., Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 333 South Columbia Street, Suite 304 MacNider Hall, Chapel Hill, NC 27514.
    Affiliations
    Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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      If you have ever been engaged in clinical research, you may have had this experience: the first six patients on the open trial of a new compound respond brilliantly, but then the next six patients completely fail to respond, shattering your fantasies of discovering a therapeutic cure. Or perhaps you have observed that initial published findings demonstrating the efficacy of the next novel treatment are not subsequently replicated—another victim of the dreaded placebo response! In this issue of Biological Psychiatry, Colloca et al. (
      • Colloca L.
      • Pine D.S.
      • Ernst M.
      • Miller F.G.
      • Grillon C.
      Vasopressin boosts placebo analgesic effects in women: A randomized trial.
      ), far from attempting to avoid the placebo response, attempt to induce it in the service of better understanding its neurobiological substrate. The authors compare the effects of intranasal oxytocin, vasopressin, and saline as well as a no-treatment condition on the analgesic efficacy of a cue (a green light) that the subjects are told will signal the presence of an electrical stimulus that will reduce the painful effects of an administered electric shock. The authors observe that the analgesic efficacy of the cue (which is inactive) is seen only in the women who received a vasopressin 1A/1B receptor agonist. The authors conclude that these sex-specific effects of vasopressin may help “shape placebo responsiveness,” possibly in the service of individualized therapeutic outcomes.
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      Linked Article

      • Vasopressin Boosts Placebo Analgesic Effects in Women: A Randomized Trial
        Biological PsychiatryVol. 79Issue 10
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          Social cues and interpersonal interactions strongly contribute to evoke placebo effects that are pervasive in medicine and depend upon the activation of endogenous modulatory systems. Here, we explore the possibility to boost placebo effects by targeting pharmacologically the vasopressin system, characterized by a sexually dimorphic response and involved in the regulation of human and nonhuman social behaviors.
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