Gourion D, Mouchabac S
17 rue des Marronniers, 75016 Paris.
Département de Psychiatrie et Psychologie Médicale, CHU Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris.
Encephale. 2016 Feb;42(1 Suppl 1):1S24-30. doi: 10.1016/S0013-7006(16)30016-1.
The placebo effect is an excellent model for understanding the mechanisms underlying the interaction between a subjective and complex mental activity (beliefs, expectations, hopes, learning, patient-physician relationship, socio-cultural context .) with different neural and biological systems. Initially, research on the placebo effect has focused on the mechanisms of pain and analgesia. The cognitive processes of conditioning and reward anticipation (hope of a relief) were highlighted. The involvement of different neurobiological pathways has been clearly shown: endogenous opioids, CCK, dopaminergic pathways, endocannabinoids, immunological factors... More recently, the field has open towards new perspectives: depression and anxiety, motor disorders, immune system, endocrine system. Intensive research in the field emerges because of its fundamental implications in neuroscience research but also because of the ethical, clinical and therapeutical issues. Moreover, the placebo effect is considered as a main methodological mean issue in clinical trials that allows the demonstration of the efficacy and tolerance of new drugs. In the field of psychiatry, depression is a placebo highly-sensitive disorder: placebo response rates in clinical trials are of the order of 30 % to 40 %. The identification of biological markers of placebo response, such as neuroimaging and quantitative electroencephalography may lead to develop more efficient models in clinical research.
安慰剂效应是理解主观且复杂的心理活动（信念、期望、希望、学习、医患关系、社会文化背景等）与不同神经和生物系统之间相互作用潜在机制的绝佳模型。最初，对安慰剂效应的研究集中在疼痛和镇痛机制上。条件作用和奖励预期（缓解的希望）的认知过程得到了突出。不同神经生物学途径的参与已得到明确证实：内源性阿片类物质、胆囊收缩素、多巴胺能途径、内源性大麻素、免疫因素等。最近，该领域朝着新的方向发展：抑郁症和焦虑症、运动障碍、免疫系统、内分泌系统。该领域的深入研究不仅因其在神经科学研究中的根本意义，还因其涉及的伦理、临床和治疗问题而兴起。此外，安慰剂效应被视为临床试验中的一个主要方法学问题，它有助于证明新药的疗效和耐受性。在精神病学领域，抑郁症是一种对安慰剂高度敏感的疾病：临床试验中的安慰剂反应率约为30%至40%。识别安慰剂反应的生物标志物，如神经影像学和定量脑电图，可能会在临床研究中开发出更有效的模型。
