The functional neuroanatomy of the placebo effect

Helen S. Mayberg, J. Arturo Silva, Steven K. Brannan, Janet L. Tekell, Roderick K. Mahurin, Scott McGinnis, Paul A Jerabek

Research output: Contribution to journalArticle

537 Citations (Scopus)

Abstract

Objective: Administration of placebo can result in a clinical response indistinguishable from that seen with active anti-depressant treatment. Functional brain correlates of this phenomenon have not been fully characterized. Method: Changes in brain glucose metabolism were measured by using positron emission tomography in hospitalized men with unipolar depression who were administered placebo as part of an inpatient imaging study of fluoxetine. Common and unique response effects to administration of placebo or fluoxetine were assessed after a 6-week, double-blind trial. Results: Placebo response was associated with regional metabolic increases involving the prefrontal, anterior cingulate, premotor, parietal, posterior insula, and posterior cingulate and metabolic decreases involving the subgenual cingulate, parahippocampus, and thalamus. Regions of change overlapped those seen in responders administered active fluoxetine. Fluoxetine response, however, was associated with additional subcortical and limbic changes in the brainstem, striatum, anterior insula, and hippocampus, sources of efferent input to the response-specific regions identified with both agents. Conclusions: The common pattern of cortical glucose metabolism increases and limbic-paralimbic metabolism decreases in placebo and fluoxetine responders suggests that facilitation of these changes may be necessary for depression remission, regardless of treatment modality. Clinical improvement in the group receiving placebo as part of an inpatient study is consistent with the well-recognized effect that altering the therapeutic environment may significantly contribute to reducing clinical symptoms. The additional subcortical and limbic metabolism decreases seen uniquely in fluoxetine responders may convey additional advantage in maintaining long-term clinical response and in relapse prevention.

Original languageEnglish (US)
Pages (from-to)728-737
Number of pages10
JournalAmerican Journal of Psychiatry
Volume159
Issue number5
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Neuroanatomy
Placebo Effect
Fluoxetine
Placebos
Gyrus Cinguli
Inpatients
Glucose
Brain
Therapeutic Uses
Depressive Disorder
Secondary Prevention
Thalamus
Positron-Emission Tomography
Brain Stem
Hippocampus
Depression
Therapeutics

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Mayberg, H. S., Silva, J. A., Brannan, S. K., Tekell, J. L., Mahurin, R. K., McGinnis, S., & Jerabek, P. A. (2002). The functional neuroanatomy of the placebo effect. American Journal of Psychiatry, 159(5), 728-737. https://doi.org/10.1176/appi.ajp.159.5.728

The functional neuroanatomy of the placebo effect. / Mayberg, Helen S.; Silva, J. Arturo; Brannan, Steven K.; Tekell, Janet L.; Mahurin, Roderick K.; McGinnis, Scott; Jerabek, Paul A.

In: American Journal of Psychiatry, Vol. 159, No. 5, 2002, p. 728-737.

Research output: Contribution to journalArticle

Mayberg, HS, Silva, JA, Brannan, SK, Tekell, JL, Mahurin, RK, McGinnis, S & Jerabek, PA 2002, 'The functional neuroanatomy of the placebo effect', American Journal of Psychiatry, vol. 159, no. 5, pp. 728-737. https://doi.org/10.1176/appi.ajp.159.5.728
Mayberg HS, Silva JA, Brannan SK, Tekell JL, Mahurin RK, McGinnis S et al. The functional neuroanatomy of the placebo effect. American Journal of Psychiatry. 2002;159(5):728-737. https://doi.org/10.1176/appi.ajp.159.5.728
Mayberg, Helen S. ; Silva, J. Arturo ; Brannan, Steven K. ; Tekell, Janet L. ; Mahurin, Roderick K. ; McGinnis, Scott ; Jerabek, Paul A. / The functional neuroanatomy of the placebo effect. In: American Journal of Psychiatry. 2002 ; Vol. 159, No. 5. pp. 728-737.
@article{3cd885f46bd24d518ce26afa30338a3a,
title = "The functional neuroanatomy of the placebo effect",
abstract = "Objective: Administration of placebo can result in a clinical response indistinguishable from that seen with active anti-depressant treatment. Functional brain correlates of this phenomenon have not been fully characterized. Method: Changes in brain glucose metabolism were measured by using positron emission tomography in hospitalized men with unipolar depression who were administered placebo as part of an inpatient imaging study of fluoxetine. Common and unique response effects to administration of placebo or fluoxetine were assessed after a 6-week, double-blind trial. Results: Placebo response was associated with regional metabolic increases involving the prefrontal, anterior cingulate, premotor, parietal, posterior insula, and posterior cingulate and metabolic decreases involving the subgenual cingulate, parahippocampus, and thalamus. Regions of change overlapped those seen in responders administered active fluoxetine. Fluoxetine response, however, was associated with additional subcortical and limbic changes in the brainstem, striatum, anterior insula, and hippocampus, sources of efferent input to the response-specific regions identified with both agents. Conclusions: The common pattern of cortical glucose metabolism increases and limbic-paralimbic metabolism decreases in placebo and fluoxetine responders suggests that facilitation of these changes may be necessary for depression remission, regardless of treatment modality. Clinical improvement in the group receiving placebo as part of an inpatient study is consistent with the well-recognized effect that altering the therapeutic environment may significantly contribute to reducing clinical symptoms. The additional subcortical and limbic metabolism decreases seen uniquely in fluoxetine responders may convey additional advantage in maintaining long-term clinical response and in relapse prevention.",
author = "Mayberg, {Helen S.} and Silva, {J. Arturo} and Brannan, {Steven K.} and Tekell, {Janet L.} and Mahurin, {Roderick K.} and Scott McGinnis and Jerabek, {Paul A}",
year = "2002",
doi = "10.1176/appi.ajp.159.5.728",
language = "English (US)",
volume = "159",
pages = "728--737",
journal = "American Journal of Psychiatry",
issn = "0002-953X",
publisher = "American Psychiatric Association",
number = "5",

}

TY - JOUR

T1 - The functional neuroanatomy of the placebo effect

AU - Mayberg, Helen S.

AU - Silva, J. Arturo

AU - Brannan, Steven K.

AU - Tekell, Janet L.

AU - Mahurin, Roderick K.

AU - McGinnis, Scott

AU - Jerabek, Paul A

PY - 2002

Y1 - 2002

N2 - Objective: Administration of placebo can result in a clinical response indistinguishable from that seen with active anti-depressant treatment. Functional brain correlates of this phenomenon have not been fully characterized. Method: Changes in brain glucose metabolism were measured by using positron emission tomography in hospitalized men with unipolar depression who were administered placebo as part of an inpatient imaging study of fluoxetine. Common and unique response effects to administration of placebo or fluoxetine were assessed after a 6-week, double-blind trial. Results: Placebo response was associated with regional metabolic increases involving the prefrontal, anterior cingulate, premotor, parietal, posterior insula, and posterior cingulate and metabolic decreases involving the subgenual cingulate, parahippocampus, and thalamus. Regions of change overlapped those seen in responders administered active fluoxetine. Fluoxetine response, however, was associated with additional subcortical and limbic changes in the brainstem, striatum, anterior insula, and hippocampus, sources of efferent input to the response-specific regions identified with both agents. Conclusions: The common pattern of cortical glucose metabolism increases and limbic-paralimbic metabolism decreases in placebo and fluoxetine responders suggests that facilitation of these changes may be necessary for depression remission, regardless of treatment modality. Clinical improvement in the group receiving placebo as part of an inpatient study is consistent with the well-recognized effect that altering the therapeutic environment may significantly contribute to reducing clinical symptoms. The additional subcortical and limbic metabolism decreases seen uniquely in fluoxetine responders may convey additional advantage in maintaining long-term clinical response and in relapse prevention.

AB - Objective: Administration of placebo can result in a clinical response indistinguishable from that seen with active anti-depressant treatment. Functional brain correlates of this phenomenon have not been fully characterized. Method: Changes in brain glucose metabolism were measured by using positron emission tomography in hospitalized men with unipolar depression who were administered placebo as part of an inpatient imaging study of fluoxetine. Common and unique response effects to administration of placebo or fluoxetine were assessed after a 6-week, double-blind trial. Results: Placebo response was associated with regional metabolic increases involving the prefrontal, anterior cingulate, premotor, parietal, posterior insula, and posterior cingulate and metabolic decreases involving the subgenual cingulate, parahippocampus, and thalamus. Regions of change overlapped those seen in responders administered active fluoxetine. Fluoxetine response, however, was associated with additional subcortical and limbic changes in the brainstem, striatum, anterior insula, and hippocampus, sources of efferent input to the response-specific regions identified with both agents. Conclusions: The common pattern of cortical glucose metabolism increases and limbic-paralimbic metabolism decreases in placebo and fluoxetine responders suggests that facilitation of these changes may be necessary for depression remission, regardless of treatment modality. Clinical improvement in the group receiving placebo as part of an inpatient study is consistent with the well-recognized effect that altering the therapeutic environment may significantly contribute to reducing clinical symptoms. The additional subcortical and limbic metabolism decreases seen uniquely in fluoxetine responders may convey additional advantage in maintaining long-term clinical response and in relapse prevention.

UR - http://www.scopus.com/inward/record.url?scp=0036237860&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036237860&partnerID=8YFLogxK

U2 - 10.1176/appi.ajp.159.5.728

DO - 10.1176/appi.ajp.159.5.728

M3 - Article

VL - 159

SP - 728

EP - 737

JO - American Journal of Psychiatry

JF - American Journal of Psychiatry

SN - 0002-953X

IS - 5

ER -