Last week, we covered a hidden placebo effect that can amplify responses to any med that

is started on the first visit.

Today, we're going to flip that on its head.

I call it the placebo flip, and antipsychiatrists are going to hate me for this one.

It's when patients paradoxically get better after stopping a medication.

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

I'm Chris Saken, the editor-in-chief of the Carlat Psychiatry Report.

And I'm Kelly Newsom, a psychiatric

MP and a dedicated reader of every issue. Imagine, you have a chronic illness like bipolar,

schizophrenia, or a current depression. You've been to the doctor for a few episodes,

but each time you managed to convince yourself that it was

just a temporary reaction to stress. After the fourth episode, though, you start to accept something a bit

more dreary. This is your life. You're not like the other people. You have a chronic mental illness,

and you're going to have to stay on a medication to remain well. It's a tough pill to swallow.

But to make things worse, that feeling of wellness never really comes. Yes, you are no longer in the

hospital or in bed all day, and you can hold a job, though not at your educational level,

but your mind is slowed. You get anxious for no reason, and you are so fatigued sometimes that it's an effort to move.

It's been like this for a few years, and your doctor says that you are in recovery,

but you start to wonder if your medication is causing some of these problems.

Your doctor is nice, but a bit too optimistic, and maybe isn't telling you the whole story.

So you stop your med.

The first day, a little withdrawal, no big deal, you can handle it.

...