Less worry, more optimism: Can antidepressant treatments be improved in real time?

Antidepressant treatments often come with strong placebo and nocebo effects. Do I think the treatment is working? Am I afraid of side effects? And if so, do I think I can cope with them? Patients often answer these questions very differently – and therefore unconsciously influence how their treatment goes. Particularly when they have already been through a series of failed treatment attempts, people with depression often have a negative attitude towards new treatments, have little hope of improvement, and worry a great deal about unpleasant side effects. However, this can have a huge impact on the success of their treatment.

The fear of side effects can make them stronger

In the first funding period of our Collaborative Research Centre, we found in Project A15 that negative treatment expectations can strongly impair the effect of antidepressants. This applies on the one hand to the effect of the antidepressant itself: If a patient doesn’t expect any benefit from an active ingredient, the chance of successful treatment is reduced. On the other hand, worries about side effects increase the risk that unpleasant side effects will actually occur – and this, in turn, is one of the most important reasons why patients discontinue their treatment.

Just-in-time adaptive interventions to optimize treatment expectations

To better help people with depression, in the second funding period, we are working on a novel concept that aims to counteract negative treatment expectations and thus improve treatment success. This involves the use of ‘just-in-time adaptive interventions’ (JITAI), in which participants receive daily individualized feedback that is adapted to their current expectations. Can this approach be used to reduce negative expectations at an early stage and improve overall treatment expectations? Does it lead to fewer side effects and make people more likely to continue with their treatment? What effect do short-term interventions have on the long-term success of antidepressant treatment? In Project A15, we will be researching these questions over the coming years.