Evidence of a Media-Induced Nocebo Response Following a Nationwide Antidepressant Drug Switch

Abstract

In 2017, patients on a generic or branded antidepressant venlafaxine were switched to a new generic formulation (Enlafax). In February and April 2018, two major NZ media outlets ran stories about the new generic being less effective and causing specific side effects. This study aimed to examine the effect of the media coverage on drug side effects reported to the national Centre for Adverse Reactions Monitoring (CARM) and whether the specific symptoms reported in the media increased compared to side effects not reported in the media. We analysed monthly adverse reaction reports for Enlafax to CARM from October 2017 to June 2018 and compared adverse reports, complaints of decreased therapeutic effect and specific symptom reports before and after the media coverage using an interrupted time series analysis. We found the number of side effects and complaints of reduced therapeutic effect increased significantly following the media stories (interruption effect = 41.83, 95% CI [25.25, 58.41], p = .003; interruption effect = 15.49, 95% CI [7.01, 23.98], p = .012, respectively). The specific side effects mentioned in the media coverage, including suicidal thoughts, also increased significantly compared to other side effects not mentioned in the media. In the context of a drug switch, media reports of side effects appear to cause a strong nocebo response by increasing both the overall rate of side effect reporting and an increase in the specific side effects mentioned in the media coverage, including reduced drug efficacy and heightened suicidal thoughts. The study provides further evidence that media coverage of side effects can induce a nocebo effect. This is the first study to look at media coverage of an antidepressant brand switch. The increase in reported adverse events was higher for those symptoms mentioned in the media reports. The study provides further evidence that media coverage of side effects can induce a nocebo effect. This is the first study to look at media coverage of an antidepressant brand switch. The increase in reported adverse events was higher for those symptoms mentioned in the media reports.

Study of mental health outcomes associated with different brands of venlafaxine at the Kumeu medical centre from January 2017 to October 2018

“…A study has subsequently been published suggesting that the spike in reporting of side effects and complaints of reduced therapeutic effect following the change in venlafaxine brand that followed media attention to this issue on 28 February 2018, and again in April 2018, was an example of the nocebo effect. 17 However, no patient in the current audit was aware of any media attention to this issue when the matter was raised with them in recent months, and in 10 of the 12 patients who experienced the apparent loss of effectiveness, the relevant clinical observations were recorded in the patient notes between August and December 2017, prior to any public attention to the issue (Table 3). Only 1 of the 15 patients in the audit admitted to any concerns about the change in venlafaxine brand (Table 3).…”

The effect of television and print news stories on the nocebo responding following a generic medication switch

“…This compulsory nationwide switch had been initiated by Pharmac – the New Zealand government’s pharmaceutical agency. The articles described patients’ concerns that Enlafax was less effective and was causing side effects such as suicidal thoughts, nausea and headaches (see MacKrill et al, 2019 for further details of the newspaper reports).…”

“…A recent nationwide switch from a branded to generic antidepressant medicine in New Zealand in 2017 provided us with the opportunity to investigate the impact of newspaper stories on the nocebo effect. In this previous study we examined how newspaper stories published in February and April 2018 influenced side effect reporting up to July 2018 ( MacKrill et al, 2019 ). We found the number of side effects, particularly those mentioned in the stories, and complaints of reduced dug efficacy increased immediately after the newspaper stories before returning to baseline levels.…”

Nocebo effects on motor performance: A systematic literature review

“…The nocebo response has the opposite effects, which can lead to considerable suffering, non‐adherence and increased drop‐out in clinical settings and trials (Barsky, Saintfort, Rogers & Borus, 2002; Colloca & Barsky, 2020; Petrie & Rief, 2019), and may also result in fall incidents (Winblad, Kilander, Eriksson et al., 2006), breathing restrictions (Schenk, 2008) and impaired mobilization (Zech, Seemann, Grzesiek, Breu, Seyfried & Hansen, 2019). Beyond medical settings, the placebo and nocebo phenomena can impact the physiological, behavioral affective, and cognitive functioning of healthy individuals, too (Colloca & Barsky, 2020; Drici, Raybaud, Lunardo, de, Iacono & Gustovic, 1995; MacKrill, Gamble, Bean, Cundy & Petrie, 2019; Mlynski, Wright & Kelly, 2020; Petrie & Rief, 2019; Schmid, Theysohn, Ga et al., 2013; Turi, Bjørkedal, Gunkel, Antal, Paulus & Mittner, 2018). The current systematic review focuses on the nocebo effect with respect to another important yet much‐overlooked area: motor performance.…”