I understand a lot of anti-depressants, anti-anxiety and anti-psychotic drugs that we’re using today have had quite a long history, we’re talking about a few ten years. But is it possible, that what works in some of them, is not the active ingredients in it, but the fact that it’s prescribed and taken, and patient’s belief in the pill(s), so the patient feels better? (If this definition is not clear enough for what placebo effect is, please check google here.)

Recently we have this typical anti-psychotic drugs ran out in the whole of country (i.e. nowhere you can find this drug, unless some expired ones in an old patient’s drawer). So having no choice the psychiatrist has had to replace it with other drugs, drug A, a stimulant that works the same but will be more stimulating (so patients can’t take it at night to avoid sleep disturbances) or drug B, another anti-psychotic that’s more sedative (suitable for patients to take at night).

Most of the patients are fine after the replacement of this old anti-psychotic drug, whether it’s with drug A or B, some with other medicine more applicable and appropriate for their current situations. Except two patients.

They both claimed that after replacing the medicine, they find it difficult to fall asleep (a common symptoms of anxious people: difficulty getting into sleep). When we tried to explain that the old drug is non-sedative (not assisting you to sleep) but also non-stimulating (not making you more awake/alert), and that 95% other patients who’ve had the medicine replaced found no problems, these two patients insisted that they need this old anti-psychotic drug to sleep.

In fact for one of the patients, the psychiatrist has come to realize that she’s no longer present with agitation or any psychotic-related symptoms, and so has replaced it with a tranquiliser, which should in fact be sedative and make her sleep better, as compared to the old anti-psychotic drug. But still, she struggled.

As a psychologist, I’d always observed and noticed the psychological effects of psychiatric drugs. How’d you explain this? Can we start to prescribe some placebo to help patients to sleep better?