You can give the right medicine the wrong way. Today, Alan Francis shows us how a strong

therapeutic alliance improves outcomes from the emergency room to the therapy couch.

Welcome to the Carlet Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Hagan, the editor-in-chief of the Carlott Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

When we left off last week, Dr. Francis shared with us a remarkable statistic that is

held true from Hippocrates to Carl Jung to modern antidepressant

trials. In each case, the outcomes are similar. A third of patients recover. A third gets somewhat

better, and a third don't change much at all. That is remarkable consistency considering

how different each of these treatment approaches are.

But they speak to a common ingredient that goes across all therapies.

Some call that ingredient the placebo, but that makes it sound kind of like a parlor trick,

the power of suggestion.

This placebo effect is bigger than a sugar pill, and it includes the natural course of illness,

the therapeutic relationship, and the patient's own inner resilience.

Last August, a pivotal paper came out that ranked psychiatric disorders based on how they

respond to the placebo. Here's what they found.

At the top of major depression and generalized anxiety disorder. And here the placebo effect is

even higher for children and for mild cases. Next, in the middle of panic disorder, ADHD,

PTSD, sociophobia, and bipolar mania.

Yes, a lot of mania trials were done in the hospital, and mania responds to a structured

environment with regular activity in wake times, not to mention PRN benzos that are often allowed

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