PREVIOUS MEDICATION, DURATION OF ILLNESS AND PLACEBO RESPONSE

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Abstract
Evidence is provided that the kind of prior medication which the patient has been taking up to drug study onset, as well as the patient''s response to such medication, influences the patient''s subsequent placebo response. Improvement produced by placebo was lowest when patients were on an active prior drug, and highest when patients were on an inactive prior drug. In another study, patients improved least on placebo, when experiencing good results with prior medications, as contrasted with patients who previously had negative drug experiences. Turning from a discussion of the effect that prior medication may have on treatment outcome, we could also show that both chronicity and the number of drugs preveously taken influenced placebo response. Drug patients were not reliably affected by these factors. The larger drugplacebo differences in the more chronically ill, more pretreated groups was, frankly, unexpected. The fact that the physicians'' ratings revealed drug effects in the acutely ill patient subgroup and in patients with only one previous drug experience suggests that they are better able to evaluate the therapeutic significance of the "placebo response." Perhaps the most parsimonious explanation for both the prior and previous medication data (patient self-ratings of improvement) is this: Having once experienced a "satisfactory" response to medication, the patient develops and employs this frame of reference to evaluate the "goodness" of subsequent medications. His response to placebo will be more objective, and therapeutically worse, if he has been pretreated with a "good" medication. Along these lines it seems reasonable to assume that patients who have received two or more medications in the past are more likely to have had a satisfactory drug experience than those patients who have had only one (and of course, no) previous drug exposure.

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