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Author Topic: How benefitial is the VNS?  (Read 12239 times)
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« on: April 08, 2009, 03:42:58 PM »

I had brain surgery, but the sz continued and the doctors tell me I can have another surgery.  But the doctors also suggested that I could also try different treatments.  I am looking at the VNS and I have found the medical information and other forms, but it seems like the people are only complaining.  So I was wondering if I could get some input from the people here.
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« Reply #1 on: April 09, 2009, 02:39:49 AM »

Hi Justin,

There are as many responses to VNS as there are people.  This site was created for patients who have been implanted for epilepsy or depression to share their experiences good and bad.

You may see more negative than positive posts...we guess that people who have had good experiences with the surgery and good responses from the VNS don't have a reason to go looking for anything.

I was implanted in May 2006 for depression.  I've had some good benefits; I've also had some difficult permanent side effects (change in voice, muscle spasms in my neck during stimulation that affects swallowing and breathing, etc.)

I'd suggest you become a member to gain access to everything.  Take some time to browse thru the'll find many of your questions answered there.

We welcome newcomers and are so happy to provide information they may not find elsewhere.  When you've looked around a bit...if you have questions....ASK!!!

Welcome to the site!  :Welcome:    Oreo

The most successful people are those who are good at plan B.
~James Yorke~
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« Reply #2 on: April 09, 2009, 02:56:19 AM »

:D HI justin4454!  On behalf of all of us  :Welcome: to the VNS Message Board!  You came to the right place to ask all the questions you have and we will do our best to answer them and direct you to the right places for information.  I am sure you have read about a lot of complaints, and here you will read that too, but you can also read about success stories as well.  All of us have direct experience with VNS, and all the stories you can read are first person experience.  Please register to become a member so you can take full advantage of everything you can access here on the site.

Please go to the main page of the board where you can find links to the Patient and Physicians Manuals.  Patients are not given the manual until after implant unless they ask for them.  In the manuals are tons of information about VNS including health history exclusions.  There are warnings and precautions and there are side effects listed as well.  Please also know that VNS takes time to work and it is not a cure all, but is an adjuctive therapy.  Everyone is different and responds differently to VNS.

Also know that a lot of insurance companies do not cover VNS Therapy for treament of depression, but a lot of insurance companies will pay for it when prescribed for epilepsy.  I gather your diagnosis is epilepsy, but please research to make sure your insurance will cover it.  The billing codes are in the Physicians Manuals.  Also know that if VNS causes you side effects that are not tolerable and/or it does not help you, there is a good chance of complete removal (meaning the generator and coils wrapped around the vagus nerve)  It is not guaranted the doc will attempt to remove the coils, but there are several of us here that have had complete removal.  

You may have been told that VNS implant charges are $25,000, and that is not true.  Patients insurance companies are being charged double that amount, and then there are costs for each adjustment.  When the battery depleats, it is not just a simple replace the battery thing-the whole generator will be replaced and it is a costly little thing involving another surgery.  Battery depleation depends on how high the device is set -the higher the miliamps, the quicker the battery depleats.

I hope I am not being Mrs. Negative...I am just presenting to you some facts you can verify, and things to consider.  I look forward to getting to know you, and hope I have been of some assistance to you.  Please visit again and keep us updated.

Take great care!
« Last Edit: April 09, 2009, 03:05:54 AM by Dispatch » Logged

VNS for TRD implant November, 2006.  Complete device removal including coils April, 2008.

"I reckon it's again my turn to win some or learn some..." Jason Mraz

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« Reply #3 on: April 09, 2009, 02:01:05 PM »

justin4454, Hi Justin, how are you doing today? I am sure you will find many people who will tell you that VNS works great for them, but my familys' personal experience with the VNS has been a complete nightmare from hell. My younger sister Judy, 45, had a vns implanted for seizure control in Febuary of last year. She has been in a mental institution since. Judy was a very respected and well liked registered nurse who was working full time to raise her beautiful 10 year old daughter by herself, and was in the process of purchasing her first home. She has a seizure disorder like I, and several other members of my immediate family have. Hers were not being very well controlled with the particular medicine she was on so a doctor she was sent to recommended VNS. Justin, I don't know you at all, but I am hoping you listen very carefully before you make your decision. Judy did all kinds of research on this thing. She worked in a hospital and had access to all kinds of info, but unfortunetly she did not do the most important thing she could have done, and that is visiting this web-site. No one knows better what the effects are and what to expect than the people who actually have one. Noone knows the impact of what it can do to your family if it does not work out then someone who is going through that hell themselves, like me. I will never have my Judy back again the way she was. This device not only increased her seizure activity but made them worse. She developed a serious psychosis which is a possible side effect, and has been in a mental institution ever since. I don't know when or if she will ever get out. She has not seen her daughter except one time for over a year. She will never be able to practice nursing again after being in a mental institution. Her home and vehicle and beloved pets and everything she held dear to her heart and worked so hard for are all gone. I am not a doctor, so I do not have the right to tell you not to get one. But I am a victim of what this device can do to your family. Not a single day goes by that I don't think about how much my sister has lost and wonder if she will ever come back to us. I miss her Justin. I miss her so much my heart aches. But I will never, ever get that same person back. The device was finally removed but the damage it has caused is permanent. Think hard, Justin. Just how much are you willing to lose?   NancyB
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« Reply #4 on: April 10, 2009, 04:09:25 AM »

Hi Justin4454,

First of all, I want to affirm you for researching and reaching out for support before undergoing surgery.  There are so many things to read on this forum, including the Patient Manual, which is crucial that you read fully, so please take advantage of it all by becoming a member.  This is usually not given to patients until AFTER the surgery, therefore we stress you read through it and ask your doctor(s) about anything you see which causes you to question this treatment.  

Secondly, as Oreo mentioned, you will see testimonies by current and past VNS patients or their family members.  It is important to see these as their own experience, however remember that each person is unique therefore we do not all have the same results.  There have been some who have gained wonderful results, but unfortunately many have not posted much other than they are doing well or it is working.  The assumption is that they don't see the forum as necessary as they might have in the beginning since they are gaining benefits, and there is validity to that thought.  

And finally, there are a few things you should ask of your doctor(s):
1)  How many patients has your doctor put on VNS?
2)  How many have found it beneficial?  What have the benefits been?
3)  How many have had to stop VNS or have it removed due to side affects?
4)  How long has your doctor(s) been doing VNS adjustments?
5)  If VNS is non-beneficial for you, will the neurosurgeon who implants it willing to completely remove it?  (Complete removal includes the stimulator, leads and coils.. not just the stimulator and leads.)
6)  What methods of diagnosis will the doctor be using for future problems since the VNS does not allow MRI and there are even issues regarding CT Scans?

Also please ask your doctor to hook you up with one of his/her patients who has been through the surgery and has VNS so you can talk with someone face-to-face who has been through the surgery, healing, adjustments, etc.  I did this and it helped me immensely from the beginning to the end when I had the VNS removed due to not being beneficial for me.  I have changed from a neurologist to an epileptologist and am going through med changes now to see if a different "cocktail" can handle the seizures better.

And if my hunch is right here... Happy Belated Birthday!  (Guessing from your name, as I am a 4th month 4th day baby too!)  If I am wrong, it won't be the last time... but if I am right I could not let a birthday wish go by.
« Last Edit: April 10, 2009, 04:10:06 AM by gel61820 » Logged

"Do not go where the path may lead, go instead where there is no path and leave a trail." Ralph Waldo Emerson

VNS implanted July 2007 for Epilepsy.  Activated August 2007.  No success, so VNS was turned off in August 2008 and COMPLETELY removed (including coils) on Nov 25, 2008.

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« Reply #5 on: April 11, 2009, 03:54:38 AM »

Hi Justin. Your reaction was much like mine when I first visited this board. Also like you, I wanted and needed to research everything I could get my hands on so that I could make the most informed decision possible. And in the end, that's what you have to do. Weigh everything and make your own decision. Just please be sure to examine all possible options.

As for this board, there are many great, caring people here. Those who have had great experiences and those who have not. And there are those of us who have had both. My VNS was for treatment resistant depression and it worked great. However, the side effects became intolerable and I just had it removed. I'll be posting an update on that in the personal stories thread in just a bit.

This board is not meant to scare the heck out of everyone. But it took me awhile to realize and understand that. So please feel welcome here and feel like you can open and share with the members here.

Take care.


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« Reply #6 on: April 17, 2013, 02:55:29 PM »

1997 CDRH Neurological Devices Panel

DR. COSTELLO: Good afternoon, Dr. Wilkinson and members of the panel. This afternoon, I will be discussing issues regarding the safety and effectiveness of the vagus nerve stimulation device......................One-third of the patients had some type of an increase in seizures, with 17 percent having greater than a 25 percent increase.................This slide shows each of the studies and the percent seizure increase. As you can see, in each of the studies, there were patients who had greater than a 100 percent increase. In the E05 study, the range went up to a 234 percent increase, while in the E04 study, it went even higher, to a 680 percent maximum range.

pg. 125

The VNS is just as beneficial as a placebo. Because that's all it is. It is nothing but a placebo. The placebo effect can be very powerful.

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Skeptic's Dictionary

Placebo effect

"The physician's belief in the treatment and the patient's faith in the physician exert a mutually reinforcing effect; the result is a powerful remedy that is almost guaranteed to produce an improvement and sometimes a cure." -- Petr Skrabanek and James McCormick, Follies and Fallacies in Medicine, p. 13.

The placebo effect is the measurable, observable, or felt improvement in health or behavior not attributable to a medication or invasive treatment that has been administered. [new] The placebo effect is not mind over matter; it is not mind-body medicine. 'The placebo effect' has become a catchall term for a positive change in health not attributable to medication or treatment. As is explained below, the change can be due to many things, such as regression to the mean, spontaneous improvement, reduction of stress, misdiagnosis in the first place, subject expectancy, classical conditioning, etc. [/new]

A placebo (Latin for "I shall please") is a pharmacologically inert substance (such as saline solution or a starch tablet) that seems to produce an effect similar to what would be expected of a pharmacologically active substance (such as an antibiotic).

By extension, "fake" surgery and "fake" therapies are considered placebos.

The idea of the placebo in modern times originated with H. K. Beecher. He evaluated 15 clinical trials concerned with different diseases and found that 35% of 1,082 patients were satisfactorily relieved by a placebo alone ("The Powerful Placebo," 1955). Other studies have since calculated the placebo effect as being even greater than Beecher claimed. For example, studies have shown that placebos are effective in 50 or 60 percent of subjects with certain conditions, e.g., "pain, depression, some heart ailments, gastric ulcers and other stomach complaints."* And, as effective as the new psychotropic drugs seem to be in the treatment of various brain disorders, some researchers maintain that there is not adequate evidence from studies to prove that the new drugs are more effective than placebos.

Beecher started a wave of studies aimed at understanding how something (improvement in health) could be produced by nothing (the inactive placebo). Unfortunately, many of the studies have not been of particularly high quality and have assumed that any measured improvement was caused by the placebo. In fact, it has been argued by Kienle and Kiene (1997) that, contrary to what Beecher claimed, a reanalysis of his data found "no evidence of any placebo effect in any of the studies cited by him." The reported improvements in heath were real but were due to other things that produced "false impressions of placebo effects." The reanalysis of Beecher's data claims that the improvements were due to:

Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic misjudgment, psychosomatic phenomena, misquotation, etc.

What the reanalysis shows is that there are a number of factors that can affect many treatments and the evaluation of those treatments, making it very difficult to be sure just what it is about an intervention that produces improvement or perceived improvement. We must also consider "artifacts such as the natural history of a disease (that is, the tendency for people to get better or worse during the course of an illness irrespective of any treatment at all), the fact that people behave differently when they are participating in an experiment than when they are not, a desire to please the experimental staff by providing socially desirable answers..." (Bausell 2007: 27), and a host of other factors unrelated to the pill we are administering and independently of any mechanism that we believe is producing any observed effects.

In May 2001, The New England Journal of Medicine published an article that called into question the validity of the placebo effect. "Is the Placebo Powerless? An Analysis of Clinical Trials Comparing Placebo with No Treatment" by Danish researchers Asbjørn Hróbjartsson and Peter C. Götzsche "found little evidence in general that placebos had powerful clinical effects." Their meta-analysis of 114 studies found that "compared with no treatment, placebo had no significant effect on binary outcomes, regardless of whether these outcomes were subjective or objective. For the trials with continuous outcomes, placebo had a beneficial effect, but the effect decreased with increasing sample size, indicating a possible bias related to the effects of small trials." (Most of the studies evaluated by Hróbjartsson and Götzsche were small: for 82 of the studies the median size was 27 and for the other 32 studies the median was 51.)

"The high levels of placebo effect which have been repeatedly reported in many articles, in our mind are the result of flawed research methodology," said Dr. Hróbjartsson, professor of medical philosophy and research methodology at the University of Copenhagen.*

Typical of the kind of flawed research methodology Hróbjartsson is referring to would be that of surgeon J. Bruce Moseley who performed fake knee surgery on eight of ten patients. (Fake surgery involves making an incision on the knee and stitching it up.) Six months after the surgery all the patients were satisfied customers. Rather than conclude that the patients didn't need surgery or that the surgery was useless because in time the patients would have healed on their own, he and others concluded that the healing of the eight who did not have surgery was due to the placebo effect, while the two who had real surgery were better because of having had the operation. Irving Kirsch and Guy Sapirstein have been accused of making the same kind of methodological error in their controversial meta-analysis that found that anti-depressants work by the placebo effect, rather than that anti-depressants are unnecessary and useless.

One more example should suffice to make the point that better designs of placebo studies are needed.

Forty years ago, a young Seattle cardiologist named Leonard Cobb conducted a unique trial of a procedure then commonly used for angina, in which doctors made small incisions in the chest and tied knots in two arteries to try to increase blood flow to the heart. It was a popular technique—90 percent of patients reported that it helped—but when Cobb compared it with placebo surgery in which he made incisions but did not tie off the arteries, the sham operations proved just as successful. The procedure, known as internal mammary ligation, was soon abandoned ("The Placebo Prescription" by Margaret Talbot, New York Times Magazine, January 9, 2000).*

Did Cobb show that this kind of surgery works by the placebo effect? Or did he show that the surgery was unnecessary because most of the patients would have healed on their own if nothing had been done?

To rule out the natural history of a disease or regression to the mean, many researchers have used a third control group—those who receive no treatment at all. If the placebo group shows better results than the group getting nothing, then surely the placebo is effective. Hróbjartsson and Götzsche think most of these studies, too, are flawed, mainly due to having samples that are too small or due to patients who make reports aimed at pleasing the researcher.

After the publication of the Hróbjartsson and Götzsche study, Dr. John C. Bailar III said in an editorial that accompanied the study: "The shoe is on the other foot now. The people who claim there are placebo effects are going to have to show it." The need, he said, is for large, rigorously designed studies that clearly define and measure effects of drugs and therapies versus placebos versus no intervention at all. These studies will have to clearly distinguish objective measurements (such as blood pressure, cholesterol levels, etc.) and subjective measurements (such as reports of pain or evaluative sensory observations by researchers, e.g., "I can see your tumor is smaller" or "I can see you are not as depressed as before").

The kind of study called for by Dr. Bailar has been done and several such studies are reviewed in chapter nine of R. Barker Bausell's Snake Oil Science (2007): "How We Know That the Placebo Effect Exists." One in particular is worth reviewing here. It was published in the Journal Pain two months after the Hróbjartsson and Götzsche article. "Response expectancies in placebo analgesia and their clinical relevance" was the work of Antonella Pollo et al. and demonstrated that placebos can help people with serious pain. The following is from their abstract:

Thoracotomized patients were treated with buprenorphine [a powerful pain reliever] on request for 3 consecutive days, together with a basal intravenous infusion of saline solution. However, the symbolic meaning of this basal infusion was changed in three different groups of patients. The first group was told nothing about any analgesic effect (natural history). The second group was told that the basal infusion was either a powerful painkiller or a placebo (classic double-blind administration). The third group was told that the basal infusion was a potent painkiller (deceptive administration). Therefore, whereas the analgesic treatment was exactly the same in the three groups, the verbal instructions about the basal infusion differed. The placebo effect of the saline basal infusion was measured by recording the doses of buprenorphine requested over the three-days treatment. We found that the double-blind group showed a reduction of buprenorphine requests compared to the natural history group. However, this reduction was even larger in the deceptive administration group. Overall, after 3 days of placebo infusion, the first group received 11.55 mg of buprenorphine, the second group 9.15 mg, and the third group 7.65 mg. Despite these dose differences, analgesia was the same in the three groups. These results indicate that different verbal instructions about certain and uncertain expectations of analgesia produce different placebo analgesic effects, which in turn trigger a dramatic change of behaviour leading to a significant reduction of opioid intake.

The patients who thought their IV contained a powerful pain reliever required 34% less of the analgesic than the patients who weren't told anything about their IV and 16% less than the patients who were told the IV could be either a powerful pain killer or a placebo. Each group got exactly the same amount of pain killer but their requests for the analgesic differed dramatically. The only significant difference among the three groups was the set of verbal instructions about the basal infusion. The study was too short for the differences to be explained by the natural history of recovery, regression, or any of the other alternatives found by Hróbjartsson and Götzsche.

Several things are worth noting about this experiment. The setting involves treatment being provided by medical personnel in a medical facility. This kind of setting usually involves a strong desire for recovery or relief on the part of the patient, as well as a belief that the treatment will be effective. The different verbal instructions about the basal IV would lead to different expectations. Belief, motivation, and expectation are essential to some forms of the placebo effect. Together, they are referred to as the subject-expectancy effect. Classical conditioning and suggestion by an authoritative healer seem to be triggering mechanisms for the this form of placebo effect (Bausell 2007: 131).

the psychological hypothesis: it's all in your mind

Some believe the placebo effect is purely psychological. Irving Kirsch, a psychologist at the University of Connecticut, believes that the effectiveness of Prozac and similar drugs may be attributed almost entirely to the placebo effect. He and Guy Sapirstein analyzed 19 clinical trials of antidepressants and concluded that the expectation of improvement, not adjustments in brain chemistry, accounted for 75 percent of the drugs' effectiveness (Kirsch 1998). "The critical factor," says Kirsch, "is our beliefs about what's going to happen to us. You don't have to rely on drugs to see profound transformation." In an earlier study, Sapirstein analyzed 39 studies, done between 1974 and 1995, of depressed patients treated with drugs, psychotherapy, or a combination of both. He found that 50 percent of the drug effect is due to the placebo response.

A person's beliefs and hopes about a treatment, combined with their suggestibility, may have a significant biochemical effect, however. Sensory experience and thoughts can affect neurochemistry. The body's neurochemical system affects and is affected by other biochemical systems, including the hormonal and immune systems. Thus, it is consistent with current knowledge that a person's hopeful attitude and beliefs may be very important to their physical well-being and recovery from injury or illness. But it does not follow from this fact that if the patient has hope will she recover. Nor does it follow from this fact that if a person is not hopeful she will not recover.

The psychological explanation seems to be the one most commonly believed. Perhaps this is why many people are dismayed when they are told that the effective drug they are taking is a placebo. This makes them think that their problem is "all in their mind" and that there is really nothing wrong with them. Yet, there are too many studies that have found objective improvements in health from after being given placebos to support the notion that the placebo effect is entirely psychological.

Doctors in one study successfully eliminated warts by painting them with a brightly colored, inert dye and promising patients the warts would be gone when the color wore off. In a study of asthmatics, researchers found that they could produce dilation of the airways by simply telling people they were inhaling a bronchodilator, even when they weren't. Patients suffering pain after wisdom-tooth extraction got just as much relief from a fake application of ultrasound as from a real one, so long as both patient and therapist thought the machine was on. Fifty-two percent of the colitis patients treated with placebo in 11 different trials reported feeling better -- and 50 percent of the inflamed intestines actually looked better when assessed with a sigmoidoscope ("The Placebo Prescription" by Margaret Talbot, New York Times Magazine, January 9, 2000).*

It is unlikely that such effects are purely psychological, though I must admit that I don't find the expression 'purely psychological' very precise or clear.

In fact, Martina Amanzio et al. (2001) demonstrated that "at least part of the physiological basis for the placebo effect is opioid in nature" (Bausell 2007: 160). We can be conditioned to release such chemical substances as endorphins, catecholamines, cortisol, and adrenaline. One reason, therefore, that people report pain relief from both acupuncture and sham acupuncture is may be that both are placebos that stimulate the opioid system.
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« Reply #7 on: April 17, 2013, 03:06:15 PM »

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Definitions, effects, and ethics
See also: Medical ethics

A placebo has been defined as "a substance or procedure… that is objectively without specific activity for the condition being treated". Under this definition, a wide variety of things can be placebos and exhibit a placebo effect. Pharmacological substances administered through any means can act as placebos, including pills, creams, inhalants, and injections. Medical devices such as ultrasound can act as placebos. Sham surgery, sham electrodes implanted in the brain, and sham acupuncture, either with sham needles or on fake acupuncture points, have all exhibited placebo effects. Bedding not treated to reduce allergies has been used as a placebo to control for treated bedding. The physician has even been called a placebo; a study found that patient recovery can be increased by words that suggest the patient “would be better in a few days”, and if the patient is given treatment, that “the treatment would certainly make him better” rather than negative words such as “I am not sure that the treatment I am going to give you will have an effect”.The placebo effect may be a component of pharmacological therapies: Pain killing and anxiety reducing drugs that are infused secretly without an individual’s knowledge are less effective than when a patient knows they are receiving them. Likewise, the effects of stimulation from implanted electrodes in the brains of those with advanced Parkinson's disease are greater when they are aware they are receiving this stimulation. Sometimes administering or prescribing a placebo merges into fake medicine.

The placebo effect has sometimes been defined as a physiological effect caused by the placebo, but Moerman and Jonas have pointed out that this seems illogical, as a placebo is an inert substance that does not directly cause anything. Instead they introduced the word "meaning response" for the meaning that the brain associates with the placebo, which causes a physiological placebo effect. They propose that the placebo, which may be unethical, could be avoided entirely if doctors comfort and encourage their patients' health. Ernst and Resch also attempted to distinguish between the "true" and "perceived" placebo effect, as they argued that some of the effects attributed to the placebo effect could be due to other factors.

The placebo effect has been controversial throughout history. Notable medical organizations have endorsed it, but in 1903 Richard Cabot concluded that it should be avoided because it is deceptive. Newman points out the "placebo paradox", – it may be unethical to use a placebo, but also unethical "not to use something that heals". He suggests to solve this dilemma by appropriating the meaning response in medicine, that is make use of the placebo effect, as long as the "one administering… is honest, open, and believes in its potential healing power". Another possible resolution of the ethical dilemma might come from the "honest placebo" effect found in a 2010 study carried out by researchers in the Program in Placebo Studies at the Harvard Medical School, where patients with irritable bowel syndrome experienced a significant beneficial effect even though they were told the pills they were taking were placebos, as compared to a control group who received no pills.


Symptoms and conditions

The placebo effect occurs more strongly in some conditions than others. One study found placebo effects are most likely to be found with the peripheral aspects of disease processes, rather than processes that reflect physical disease. Dylan Evans has suggested as another factor, that placebos work most strongly upon conditions such as pain, swelling, stomach ulcers, depression, and anxiety that have been linked with activation of the acute-phase response.

Placebo analgesia is more likely to work the more severe the pain. One study found that for postoperative pain following the extraction of the third molar, saline injected while telling the patient it was a powerful painkiller was as potent as a 6–8 mg dose of morphine.

Most research reports average reduction for a group of people, but this can be lower (some people do not respond). In one study using injection of capsaicin below the skin found that this reduced group average pain compared to no placebo by ~46% to ~57%. Another measure is the ability to endure pain. In one study, placebos increased this on average by about 3.5 minutes compared to just under 14 minutes without it. The average strength of placebos upon pain on a visual analog scale is 2 out of 10 units. Individuals who respond to placebos may show even greater effects up to 5 out of 10 units.

In 1998, a meta-analysis of published antidepressant trials found that 75% of the effectiveness of anti-depressant medication is due to the placebo effect and other non-specific effects, rather than the treatment itself. Later, meta-analyses including data from unpublished trials found that the overall difference between drug and placebo is not clinically significant except in cases of very extreme depression. Another meta-analysis found that 79% of depressed patients receiving placebo remained well (for 12 weeks after an initial 6–8 weeks of successful therapy) compared to 93% of those receiving antidepressants. A meta-analysis in 2002 found a 30% reduction in suicide and attempted suicide in the placebo groups compared to a 40% reduction in the treated groups.

A 2002 article in The Washington Post titled "Against Depression, a Sugar Pill Is Hard to Beat" summarized research as follows: "In the majority of trials conducted by drug companies in recent decades, sugar pills have done as well as -- or better than -- antidepressants. Companies have had to conduct numerous trials to get two that show a positive result, which is the Food and Drug Administration's minimum for approval. The makers of Prozac had to run five trials to obtain two that were positive, and the makers of Paxil and Zoloft had to run even more”.

Gastric and duodenal ulcers
A meta-study of 31 placebo-controlled trials of the gastric acid secretion inhibitor drug cimetidine in the treatment of gastric or duodenal ulcers found that placebo treatments, in many cases, were as effective as active drugs: of the 1692 patients treated in the 31 trials, 76% of the 916 treated with the drug were "healed", and 48% of the 776 treated with placebo were "healed". These results were confirmed by the direct post-treatment endoscopy. It was also found that German placebos were "stronger" than others; and that, overall, different physicians evoked quite different placebo responses in the same clinical trial (p. 15). Moreover, in many of these trials the gap between the active drugs and the placebo controls was "not because [the trials' constituents] had high drug effectiveness, but because they had low placebo effectiveness" (p. 13).

In some trials, placebos were effective in 90% of the cases, whereas in others the placebos were effective in only 10% of the cases. It was argued that "what is demonstrated in [these] studies is not enhanced healing in drug groups but reduced healing in placebo groups" (p. 14). It was also noted the results of two studies (one conducted in Germany, the other in Denmark), which examined "ulcer relapse in healed patients" showed that the rate of relapse amongst those "healed" by the active drug treatment was five times that of those "healed" by the placebo treatment (pp. 14–15).

Chronic fatigue syndrome
It was previously assumed that placebo response rates in patients with chronic fatigue syndrome (CFS) are unusually high, "at least 30% to 50%", because of the subjective reporting of symptoms and the fluctuating nature of the condition. According to a meta-analysis and contrary to conventional wisdom, the pooled response rate in the placebo group was 19.6%, even lower than in some other medical conditions. The authors offer possible explanations for this result: CFS is widely understood to be difficult to treat, which could reduce expectations of improvement. In context of evidence showing placebos do not have powerful clinical effects when compared to no treatment, a low rate of spontaneous remission in CFS could contribute to reduced improvement rates in the placebo group. Intervention type also contributed to the heterogeneity of the response. Low patient and provider expectations regarding psychological treatment may explain particularly low placebo responses to psychiatric treatments.[141]

List of medical conditions
The effect of placebo treatments (an inert pill unless otherwise noted) has been studied for the following medical conditions:
ADHD: adult,[142] child[116]
Amalgam fillings: attributed symptoms (inert "chelation" therapy)[143]
Anxiety disorders[144][145]
Asthma (water aerosol inhalant)[146]
Autism: language and behavior problems[149][150]
Benign prostatic enlargement[151]
Binge eating disorder[152]
Bipolar mania[153]
Cough[6]   Crohn's disease[154]
Depression (light treatment; low red light placebo)[155]
Dyspepsia and Stomach motility[159]
Erectile dysfunction[161]
Food allergy: ability to eat ill-making foods[68] p. 54
Gastric and duodenal ulcers[68][140][162]
Heart failure, congestive[164]
Herpes simplex[165]   Hypertension: mild and moderate[64][166]
Irritable bowel syndrome[167][168]
Migraine prophylaxis[169]
Multiple sclerosis[170]
Nausea: gastric activity[171]
Nausea: chemotherapy[172]
Nausea and vomiting : postoperative (sham acupuncture)[173]
Panic disorders[175]
Parkinson's disease[176][177]
Pathological gambling[178]   Premenstrual dysphoric disorder.[179]
Psoriatic arthritis[180]
Reflux esophagitis[181]
Restless leg syndrome[182]
Rheumatic diseases[183]
Sexual dysfunction: women[184]
Social phobia[185]
Third molar extraction swelling (sham ultra-sound)[13][14]
Ulcerative colitis[186]
Vulvar vestibulitis
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