From a naïve point of view one might have expected that in psychiatry, since it covers "psychic disorders", the placebo effect (with its psychological component) might be higher and, as a consequence, the resulting true "pharmacologic" effect would be lower than in general medicine. One could also argue that in general medicine the pathophysiology and the mechanism of action of an active compound are somewhat clearer than in psychiatry and, therefore, the efficacy should be higher. But obviously neither seems to be universally valid. The astonishing similar efficacy of psychopharmacological medications and general medicine medications reminds us that many general medical conditions are, just like psychiatric conditions, of a "multifactorial" nature.
Therefore, it is not a surprise that in many medical and psychiatric conditions placebo response rates are relatively high. This may be especially true for idiopathic and functional medical conditions such as migraine, neurological disorders (such as Parkinson's disease), autoimmune disorders and asthma [5
]. In other words, not only in psychiatry but also in a variety of common medical conditions, the placebo effect seems to be modulated by the fact that the intake of any drug is inevitably embedded in a specific psychosocial context which gives rise to distinct expectations. This raises the question of why this context may be widely accepted and common sense in medical conditions on the one hand, but leads to criticism with respect to the use of medications in psychiatry on the other. Amongst others, one important reason is that there are different areas of stigmatization in psychiatry. Stigmas concerning psychiatric illnesses can be separated and differ from stigmas concerning psychopharmacology [6
In a survey on 1,088 healthy subjects in Germany from 1995, 70% of all respondents answered that medications for cardiovascular conditions are effective, while only 18% believed the medication might be effective in psychiatric conditions [7
]. In the same survey, more than 40% of the respondents feared a loss of control with psychiatric medications, but only 10% feared the same when taking medication for cardiovascular conditions [7
]. Moreover, 73% felt that high blood pressure should be treated in the first place with medications, but only 1% believed in the efficacy of psychotherapy in that indication. In contrast, severe paranoia should be treated with medication according to only 4% of the respondents, but 64% believed that psychotherapy would be a successful treatment [7
]. Against this background, the review by Stefan Leucht et al.
is an important contribution to overcoming the stigma against psychiatric medication and in putting its efficacy into a wider perspective.
On the other hand, it should be kept in mind that the paper by Stefan Leucht et al. only reviews pharmacological interventions which cover a part of all available medical treatment options. In psychiatry, for example, next to psychopharmacology and psychotherapy, there are other highly effective somatic treatments available, such as electro convulsion therapy (ECT) and transcranial magnetic stimulation (TMS). In general medicine, there are, of course, more and more minimally-invasive interventions available complementing the pharmacologic treatments, such as percutane transluminal coronary angioplasty (PTCA).