Expectancy of Improvement Affects Efficacy of SSRIs for Anxiety in Patients With SAD

Escitalopram G 870293428 1 — Emotional Well-being, Mental Health, Psychiatrists, Psychologists

Expectancy effects on dopamine signaling are largely accountable for anxiousness reduction via selective serotonin reuptake inhibitors (SSRIs) in patients with social anxiousness disorder (SAD), researchers located in a study published in Translational Psychiatry.

Researchers randomly assigned sex- and age-matched patients (17 males and 10 girls aged 31.1±10.3 years) with SAD to either overt (n=14) or covert (n=13) therapy with escitalopram 20 mg day-to-day for 9 weeks (following 1 week of 10 mg) just after assessing them with positron emission tomography (PET). Patients who had lately ended or had been undergoing psychiatric therapy had been excluded from the study.

Patients received diverse descriptions of the efficacy of the drug. Researchers told the patients in the overt group that they would obtain escitalopram, which was demonstrated to be helpful for SAD. They told the men and women in the covert group that they would obtain a non-helpful neurokinin-1-receptor antagonist, an active placebo with side effects that mimicked these of escitalopram but devoid of any expectation of improvement in symptoms.

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They located that patients in the overt group seasoned decreased availability of dopamine (DAT) nondisplaceable binding potentials (BPND) though the covert group seasoned increases in BPND.

Serotonin (SERT) occupancy levels had been inversely connected with DAT BPND in the overt group and enhanced DAT BPND in the group that received covert therapy.

Logistic regression evaluation of transporter modifications and group indicated that such as SERTxDAT interaction to the models with principal effects of SERT and DAT drastically raised R2 variance (interaction/principal effects: putamen = .28/.02 left pallidum = .19/.03, proper thalamus = .41/.11), apart from in the proper pallidum (.27/.27).

Clinical evaluation just after 9 weeks located that the overt group seasoned more improvement (Mdiff ± SD = 47.07±19.23, Cohen’s d = 2.33) compared with the covert (Mdiff = 21.46±17.25, Cohen’s d = .93) group, as determined via self-report of symptoms on the Liebowitz Social Anxiety Scale (LSAS-SR). More men and women in the overt group (57%) than in the covert group (15%) responded to therapy (Fisher’s precise test: OR = .15, P =.046).

Limitations of the study incorporated only 2 of the 4 arms in the balanced placebo design and style becoming utilised and no measurement of subjective expectancies in the course of therapy.

“[T]he anti-anxiety properties of SSRIs appear to be largely dependent on expectancy effects on dopamine signaling while SERT blockade is not sufficient for symptom remission,” the investigators mentioned. “This provides new insights on the key therapeutic mechanisms of SSRIs, incorporating psychological effects on dopamine neurotransmission.”


Hjorth OR, Frick A, Gingnell M, et al. Expectancy effects on serotonin and dopamine transporters during SSRI treatment of social anxiety disorder: a randomized clinical trial. Translational Psychiatry. Published on the internet November 3, 2021. doi: 10.1038/s41398-021-01682-3

Originally published in www.psychiatryadvisor.com