The Carlat Psychiatry Podcast Psychopharm Secrets: Starting Meds
Jun 16, 2025
The complexity of the placebo effect is explored, shedding light on its varying impact across psychiatric disorders. Historical examples illustrate how patient responses can often skew perceptions of treatment efficacy. The discussion also touches on the importance of tapering medications during crises and alarming trends in recreational drug use, particularly ketamine and psilocybin. The rising popularity of these psychedelics among those facing mental health challenges raises important concerns, especially with recent data from poison control centers.
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Placebo Effect Varies by Disorder
- Placebo effects vary by psychiatric disorder with depression and anxiety showing the highest effect sizes.
- Disorders like OCD and schizophrenia show smaller but still meaningful placebo responses.
First Visit Exaggerates Improvement
- Patients often report the biggest improvement after their first visit due to the placebo effect and regression toward the mean.
- Regression toward the mean means symptoms naturally tend to move closer to average after extreme lows.
McHugh's IQ Regression Anecdote
- Paul McHugh counseled parents on regression toward the mean using intelligence examples.
- He explained gifted parents' children tend to have average IQs closer to the population mean.
