Summary
The concept of the placebo effect has received a considerable
attention over the past several decades. The placebo
effect has been observed in different psychiatric disorders,
including post-traumatic stress disorder (PTSD), a chronic
and severe disorder precipitated by exposure to a psychologically
distressing event. The placebo response rates in
patients with PTSD range from 19% to 62%. A considerable
number of research publications suggest that endogenous
opioids are involved in the mechanisms of the placebo effect.
Endogenous opioid peptides play an important role in
stress response and in the pathophysiology of PTSD. Therefore,
endogenous opioids may be involved in the neurobiology
of the placebo effect in PTSD. Possibly, the endogenous
opioid system mediates the effect of placebo on all 3 PTSD
symptom clusters (re-experiencing symptoms, avoidance
and numbing, and physiologic arousal). The placebo effectrelated
activation of the endogenous opioid system may result
in an improvement in intrusive symptomatology and
symptoms of increased arousal because the administration
of exogenous opioids improve these symptoms. The placebo
effect-related activation of the endogenous opioid system
may have a mood-enhancing effect, and, consequently,
diminish avoidance and numbing. Multiple neurotransmitter
and neuroendocrine pathways may be involved in the
mechanisms of the placebo effect in PTSD. Further studies
of the neurobiology of the placebo effect on patients with
PTSD and other psychiatric disorders may produce interesting
and important results.