{"id":445,"date":"2012-10-01T12:34:03","date_gmt":"2012-10-01T12:34:03","guid":{"rendered":"http:\/\/harpa.blogg.is\/2012-10-01\/virka-thunglyndislyf\/"},"modified":"2013-11-21T09:09:47","modified_gmt":"2013-11-21T09:09:47","slug":"virka-thunglyndislyf","status":"publish","type":"post","link":"https:\/\/harpahreins.com\/blogg\/2012\/10\/01\/virka-thunglyndislyf\/","title":{"rendered":"Virka \u00feunglyndislyf?"},"content":{"rendered":"

Einfalda svari\u00f0 vi\u00f0 \u00feessari spurningu er j\u00e1. En \u00fe\u00e1 er liti\u00f0 framhj\u00e1 \u00feeirri sta\u00f0reynd a\u00f0 \u00feunglyndislyf vir\u00f0ast virka l\u00edti\u00f0 betur en lyfleysa; a\u00f0 \u00feau eru reist \u00e1 tilg\u00e1tum en ekki v\u00edsindalegum grunni; a\u00f0 \u00feau kunni a\u00f0 valda meiri ska\u00f0a en gagni o.m.fl.<\/font><\/p>\n

\u00deunglyndislyf og meint \u00f3jafnv\u00e6gi \u00ed heila sem \u00feau eiga a\u00f0 lei\u00f0r\u00e9tta<\/font><\/b><\/p>\n

Me\u00f0 \u00feunglyndislyfjum \u00e1 \u00e9g vi\u00f0 \u00fea\u00f0 sem engilsaxneskir kalla \u201eanti-depressants\u201c. \u00cd meginatri\u00f0um m\u00e1 skipta sl\u00edkum lyfjum \u00ed \u00ferj\u00e1 lyfjaflokka: \u00der\u00edhringlaga lyf, MAO-blokka og SSRI-lyf. Nokkur lyf falla utan \u00feessara flokka. \u00d6ll eiga lyfin \u00fea\u00f0 sammerkt a\u00f0 virka \u00e1 bo\u00f0efnakerfi \u00ed heila og byggja \u00e1 \u00feeirri tilg\u00e1tu a\u00f0 eitthva\u00f0 s\u00e9 bogi\u00f0 vi\u00f0 bo\u00f0efnaskipti \u00ed heila \u00feunglyndra. S\u00fa tilg\u00e1ta ver\u00f0ur \u00e6 \u00f3sennilegri eftir \u00fev\u00ed sem ranns\u00f3knara\u00f0fer\u00f0um fleygir fram. \u00c1 hinn b\u00f3ginn er henni enn\u00fe\u00e1 haldi\u00f0 mj\u00f6g a\u00f0 \u00feunglyndissj\u00faklingum og a\u00f0standendum \u00feeirra. M\u00e1 t.d. nefna lyfjauppl\u00fdsingar \u00e1 vef Lyfjastofnunar sem flagga \u00feessari tilg\u00e1tu mj\u00f6g. Svo nefnd s\u00e9u nokkur mismunandi g\u00f6mul d\u00e6mi (feitletranir eru m\u00ednar):<\/font>
\n\u00a0<\/p>\n

SEROXAT er \u00ed flokki lyfja sem nefnd eru s\u00e9rh\u00e6f\u00f0ir ser\u00f3t\u00f3n\u00edn-enduruppt\u00f6kuhemlar (SSRI – selective\u00a0 serotonine reuptake inhibitors). \u00cd heilanum er efni sem nefnist ser\u00f3t\u00f3n\u00edn. Hj\u00e1 f\u00f3lki sem er \u00feunglynt e\u00f0a kv\u00ed\u00f0i\u00f0 er minna ser\u00f3t\u00f3n\u00edn en hj\u00e1 \u00f6\u00f0rum<\/b>. Ekki er a\u00f0 fullu lj\u00f3st hvernig SEROXAT og \u00f6nnur lyf \u00ed sama\u00a0 flokki verka en \u00fea\u00f0 getur veri\u00f0 a\u00f0 \u00feau hj\u00e1lpi me\u00f0 \u00fev\u00ed a\u00f0 auka magn ser\u00f3t\u00f3n\u00edns \u00ed heilanum. Mikilv\u00e6gt er a\u00f0 f\u00e1 vi\u00f0eigandi me\u00f0fer\u00f0 gegn \u00feunglyndi og kv\u00ed\u00f0ar\u00f6skunum til \u00feess a\u00f0 n\u00e1 bata.<\/font>
\n(\u00dar fylgise\u00f0li me\u00f0 Seroxat<\/a>, algengu SSRI-lyfi.)<\/font><\/p>\n

\u00a0 <\/font>
\nCipralex tilheyrir flokki \u00feunglyndislyfja sem er kalla\u00f0ur er s\u00e9rt\u00e6kir ser\u00f3t\u00f3n\u00edn enduruppt\u00f6kuhemlar (SSRI lyf). \u00deessi lyf verka \u00e1 ser\u00f3t\u00f3n\u00edn kerfi\u00f0 \u00ed heilanum me\u00f0 \u00fev\u00ed a\u00f0 auka magn ser\u00f3t\u00f3n\u00edns. Truflun \u00e1 ser\u00f3t\u00f3n\u00edn kerfinu er talin mikilv\u00e6gur \u00fe\u00e1ttur \u00ed myndun \u00feunglyndis <\/b>og skyldra sj\u00fakd\u00f3ma.<\/font>
\n(\u00dar fylgise\u00f0li me\u00f0 Cipralex<\/a>, algengu SSRI-lyfi.)<\/font>
\n\u00a0<\/p>\n

Anafranil\/Anafranil Retard eykur virkni \u00ed \u00e1kve\u00f0nu sv\u00e6\u00f0i heilans sem hefur \u00e1hrif \u00e1 einkenni \u00feunglyndis<\/b>.<\/font>
\n(\u00dar fylgise\u00f0li me\u00f0 Anafranil<\/a>, \u00fer\u00edhringlaga \u00feunglyndislyfi.)<\/font>
\n\u00a0<\/p>\n

Aurorix er lyf til me\u00f0fer\u00f0ar vi\u00f0 \u00feunglyndi og f\u00e9lagslegri f\u00e6lni. Aurorix tilheyrir flokki MAO-hemla. Aurorix stu\u00f0lar a\u00f0 \u00fev\u00ed a\u00f0 lei\u00f0r\u00e9tta \u00fea\u00f0 \u00f3jafnv\u00e6gi \u00ed heilastarfsemi sem veldur einkennunum<\/b>.<\/font>
\n(\u00dar fylgise\u00f0li me\u00f0 Aurorix<\/a>, MAO-blokka.)<\/font>
\n\u00a0<\/p>\n

Lyf gegn \u00feunglyndi h\u00e6kka ge\u00f0slag og vinna gegn depur\u00f0<\/font><\/b>. \u00deau hafa einnig g\u00f3\u00f0 \u00e1hrif \u00e1 kv\u00ed\u00f0a. Lyfin hafa mj\u00f6g s\u00e9rh\u00e6f \u00e1hrif \u00e1 sv\u00e6\u00f0um dj\u00fapt \u00ed heilanum. \u00dear virka \u00feau \u00e1 efnaskipti \u00ed serat\u00f3n\u00edn- og noradrenal\u00ednkerfum<\/b> en \u00fea\u00f0 eru bo\u00f0kerfi sem stj\u00f3rna \u00fdmsum st\u00f6rfum \u00feess hluta taugakerfisins sem ekki er undir stj\u00f3rn vilja og me\u00f0vitundar svo sem svefni, ge\u00f0slagi og kv\u00ed\u00f0a.<\/font>
\n(\u00d3lafur \u00de\u00f3r \u00c6varsson ge\u00f0l\u00e6knir. \u00deunglyndi. Lei\u00f0beiningar fyrir sj\u00faklinga og a\u00f0standendur<\/a><\/i>, s. 6. \u00datgefandi Actavis. \u00datg\u00e1fu\u00e1rs er ekki geti\u00f0 en \u00e6tla m\u00e1 a\u00f0 b\u00e6klingurinn hafi komi\u00f0 \u00fat \u00e1ri\u00f0 2005.)\u00a0 \u00c9g hef s\u00e9\u00f0 \u00feennan b\u00e6kling \u00e1 bi\u00f0stofu g\u00f6ngudeildar\/br\u00e1\u00f0am\u00f3tt\u00f6ku ge\u00f0svi\u00f0s \u00e1 Landsp\u00edtalanum og a\u00f0 mig minnir \u00e1 bi\u00f0stofu \u00e1 heilsug\u00e6slust\u00f6\u00f0inni \u00ed m\u00ednum heimab\u00e6 svo \u00e9g reikna me\u00f0 a\u00f0 honum hafi veri\u00f0 dreift v\u00ed\u00f0a.<\/font>
\n\u00a0<\/p>\n

Mikill fj\u00f6ldi ranns\u00f3kna bendir til a\u00f0 l\u00edffr\u00e6\u00f0ilegir \u00fe\u00e6ttir eigi sinn \u00fe\u00e1tt \u00ed \u00fer\u00f3un \u00feunglyndis. Sumar ranns\u00f3knir hafa bent til \u00f3jafnv\u00e6gis e\u00f0a skorts \u00e1 \u00e1kve\u00f0num bo\u00f0efnum \u00ed heila, enda hafa flest \u00feunglyndislyf \u00e1hrif \u00e1 virkni \u00feessara bo\u00f0efna (ser\u00f3t\u00f3n\u00edn og noradrenal\u00edn)<\/b>.<\/font>
\n(R\u00fanar Helgi Andrason og Engilbert Sigur\u00f0sson. \u201eAf hverju stafar \u00feunglyndi<\/a>?\u201c V\u00edsindavefurinn<\/i> 7.12.2000.)<\/font><\/p>\n

\u00a0 <\/font><\/p><\/blockquote>\n

\u00a0Hversu l\u00edklegt er a\u00f0 \u00feunglyndi stafi af bo\u00f0efna\u00f3jafnv\u00e6gi \u00ed heila?<\/font><\/b><\/p>\n

\u00cd upphafi er r\u00e9tt a\u00f0 hafa \u00ed huga a\u00f0 menn uppg\u00f6tvu\u00f0u ekki meint bo\u00f0aefna\u00f3jafnv\u00e6gi \u00ed heila fyrst og h\u00f6nnu\u00f0u lyfin me\u00f0 hli\u00f0sj\u00f3n af \u00fev\u00ed: \u00dea\u00f0 var nefnilega \u00f6fugt! Af slembilukku duttu menn ofan \u00e1 lyf sem virtust b\u00e6ta ge\u00f0slag sj\u00faklinga, berklasj\u00faklinga sem batna\u00f0i raunar alls ekki berklarnir en virtust meir me\u00f0 h\u00fdrri h\u00e1 af \u00feessi lyfi. \u00deetta var undanfari fyrstu \u00fer\u00edhringlaga ge\u00f0lyfjanna og fyrsti MAO-blokkinn leit sk\u00f6mmu s\u00ed\u00f0ar dagsins lj\u00f3s. Lyfin voru uppg\u00f6tvu\u00f0 laust eftir 1950. \u00c1\u00f0ur h\u00f6f\u00f0u menn reynt a\u00f0 l\u00e6kna \u00feunglyndi me\u00f0 sefandi lyfjum (t.d. \u00f3p\u00edumskyldum lyfjum og br\u00f3m\u00ed\u00f0i) e\u00f0a \u00f6rvandi lyfjum (t.d. amfetam\u00edni).<\/font><\/p>\n

\u00deegar menn t\u00f6ldu sig hafa sannreynt a\u00f0 \u00feessi lyf\u00a0b\u00e6ttu ge\u00f0slag \u00e1n \u00feess a\u00f0 vera verulega sefandi e\u00f0a verulega \u00f6rvandi f\u00f3ru \u00feeir a\u00f0 reyna \u00e1tta sig \u00e1 \u00fev\u00ed af hverju \u00fea\u00f0 v\u00e6ri. Og til var\u00f0 kenningin um \u00f3jafnv\u00e6gi \u00ed m\u00f3n\u00f3am\u00edn-kerfi heilans<\/b> (the monoamine hyptheses). \u00dev\u00ed mi\u00f0ur hefur m\u00e9r ekki tekist a\u00f0 hafa upp \u00e1 \u00edslensku or\u00f0i yfir m\u00f3n\u00f3am\u00edn. M\u00f3n\u00f3am\u00edn-taugabo\u00f0efni eru m\u00f6rg en menn hafa s\u00e9rstakan \u00e1huga \u00e1 ser\u00f3t\u00f3n\u00edni, noradrenal\u00edni og d\u00f3pam\u00edni \u00ed \u00feessari m\u00f3n\u00f3am\u00edn-kenningu um orsakir \u00feunglyndis. (Upphaflega voru menn a\u00f0allega uppteknir af noradrenal\u00edni, svo f\u00e6r\u00f0ist megin\u00feunginn \u00e1 ser\u00f3t\u00f3n\u00edn, n\u00fana nj\u00f3ta p\u00e6lingar um \u00fe\u00e1tt melant\u00f3n\u00edns \u00ed \u00feunglyndi t\u00f6luver\u00f0ra vins\u00e6lda \u00feannig a\u00f0 \u00e1herslan sveiflast nokku\u00f0 \u00ed t\u00edmans r\u00e1s.)<\/font><\/p>\n

H\u00e9r \u00e1 eftir fylgir afar einf\u00f6ldu\u00f0 \u00fatsk\u00fdring \u00e1 taugabo\u00f0efnum heilans, a\u00f0 mestu so\u00f0in saman \u00far b\u00f3kinni Unhinged<\/i>, s. 75-76, eftir Daniel Carlat og uppl\u00fdsingum \u00e1 V\u00edsindavef<\/i> (sj\u00e1 heimildalista ne\u00f0st – \u00fear er og v\u00edsa\u00f0 \u00ed efni sem \u00fatsk\u00fdrir \u00feetta miklu n\u00e1kv\u00e6mar). \u00dev\u00ed mi\u00f0ur hef \u00e9g hvergi fundi\u00f0 s\u00e6milega skiljanlega l\u00fdsingu \u00e1 bo\u00f0efnakerfinu og virkni \u00feunglyndislyfja \u00e1 \u00fea\u00f0 \u00e1 \u00edslensku eftir ge\u00f0l\u00e6kni og fagna \u00e1bendingu ef h\u00fan skyldi vera til og hafa fari\u00f0 framhj\u00e1 m\u00e9r.<\/font><\/p>\n

Heilinn er ger\u00f0ur \u00far \u00f3teljandi taugafrumum. Taugafrumur hafa samskipti me\u00f0 taugabo\u00f0um, \u00fe.e. raffr\u00e6\u00f0ilegum og efnafr\u00e6\u00f0ilegum bo\u00f0um. Taugabo\u00f0efni eru t.d. ser\u00f3t\u00f3n\u00edn, noradrenal\u00edn og d\u00f3pam\u00edn. Taugabo\u00f0efni fara\u00a0\u00far einni taugafrumu yfir \u00ed a\u00f0ra um taugam\u00f3t og tengjast \u00fear s\u00e9rh\u00e6f\u00f0um vi\u00f0t\u00f6kum. L\u00edkja m\u00e1 bo\u00f0efnunum vi\u00f0 lykla og vi\u00f0t\u00f6kunum vi\u00f0 l\u00e1sa; a\u00f0eins sum bo\u00f0efni \u201eganga a\u00f0\u201c tiltekinni ger\u00f0 vi\u00f0taka. Ser\u00f3t\u00f3n\u00edn gengur bara a\u00f0 ser\u00f3nt\u00f3n\u00edn-vi\u00f0taka, noradrenal\u00edn bara a\u00f0 noradrenal\u00edn-vi\u00f0taka\u00a0 o.s.fr.<\/font><\/p>\n

\u00deegar bo\u00f0efni hefur hitt \u00e1 sinn vi\u00f0taka ver\u00f0ur dramat\u00edsk breyting \u00e1 taugafrumunni, kalla\u00f0 bo\u00f0spenna<\/a>.\u00a0 Bo\u00f0spennan berst eftir taugafrumunni, efnaferli fara \u00ed gang og taugafruman sendir fr\u00e1 s\u00e9r taugabo\u00f0efni sem lenda \u00ed s\u00ednum vi\u00f0t\u00f6kum \u00ed n\u00e6stu taugafrumu o.s.fr. <\/font><\/p>\n

Af \u00fev\u00ed taugabo\u00f0efni eru svo mikilv\u00e6g fyrir alla heila- og l\u00edkamsstarfsemi g\u00e6tir heilinn \u00feess a\u00f0 eiga n\u00f3g af \u00feeim; s\u00edfellt eru framleidd fersk bo\u00f0efni \u00far m\u00f3lek\u00falum \u00ed v\u00f6kvas\u00fapu heilans. En jafnframt eru bo\u00f0efni endurn\u00fdtt, notu\u00f0 bo\u00f0efni eru s\u00edfellt sogu\u00f0 upp af s\u00e9rst\u00f6kum uppt\u00f6kurum\/uppt\u00f6kud\u00e6lum.<\/font><\/p>\n

SSRI lyf byggja \u00e1 \u00feeirri tilg\u00e1tu a\u00f0 of l\u00edti\u00f0 ser\u00f3t\u00f3n\u00edn s\u00e9 \u00ed heilanum. \u00deau lyf blokka ser\u00f3t\u00f3n\u00edn-upptakara sem ver\u00f0ur til \u00feess a\u00f0 ser\u00f3t\u00f3n\u00edn-bo\u00f0efni\u00f0 helst lengur \u00ed taugam\u00f3tum og ser\u00f3t\u00f3n\u00edn-magni\u00f0 \u00ed heilanum h\u00e6kkar \u00fear af lei\u00f0andi. SNRI-lyf (t.d. Efexor og Cymbalta) virka \u00e1 tvo bo\u00f0efnaupptakara og blokka enduruppt\u00f6ku ser\u00f3nt\u00f3n\u00edns og\u00a0 noradrenal\u00edns. \u00der\u00edhringlaga lyfin g\u00f6mlu hemlu\u00f0u s\u00f6mu bo\u00f0efnaupptakara og sum (t.d. Anafranil) d\u00f3pam\u00ednupptakara a\u00f0 auki. MAO-lyfin blokka ens\u00edm sem stu\u00f0la a\u00f0 ni\u00f0urbroti taugabo\u00f0efna \u00ed heilanum svo \u00e1hrifin eru \u00feau s\u00f6mu: Magn taugabo\u00f0efna \u00ed heila eykst.<\/font>
\n\u00a0
\n\u00a0<\/p>\n

\"Ser\u00f3t\u00f3n\ufffdnMenn vita sem sagt nokkurn veginn hva\u00f0 lyfin gera. En tilg\u00e1tan um a\u00f0 \u00feunglyndi stafi af of litlu magni af \u00e1kve\u00f0num bo\u00f0efnum \u00ed heila var sett fram eftir a\u00f0 lj\u00f3st var a\u00f0 lyf, sem menn h\u00e9ldu\/halda a\u00f0 virki \u00e1 \u00feunglyndi, auka magn \u00feessara bo\u00f0efna. \u00deetta er \u00f6fug s\u00f6nnunarf\u00e6rsla \u00fear sem ni\u00f0ursta\u00f0an er talin gefa forsendurnar.<\/b><\/font><\/p>\n

\u00der\u00e1tt fyrir urmul af alls konar ranns\u00f3knum hefur ekki tekist a\u00f0 s\u00fdna fram \u00e1 a\u00f0 \u00fea\u00f0 s\u00e9 einhver s\u00e9rstakur ser\u00f3t\u00f3n\u00edn e\u00f0a noradrenal\u00edn skortur \u00ed heilum \u00feunglyndra. Megni\u00f0 af ser\u00f3t\u00f3n\u00edni l\u00edkamans er a\u00f0 finna \u00ed meltingarveginum en ekki \u00ed heilanum. \u00dea\u00f0 er engin m\u00f6guleg lei\u00f0 til a\u00f0 m\u00e6la ser\u00f3t\u00f3n\u00edn \u00ed heila lifandi manns. Menn hafa gert tilraunir me\u00f0 a\u00f0 m\u00e6la ser\u00f3t\u00f3n\u00edn \u00ed m\u00e6nuv\u00f6kva en magni\u00f0 m\u00e6list tilviljanakennt eftir einstaklingum, ekki eftir \u00feunglyndi og fullkomnu ge\u00f0heilbrig\u00f0i. Menn hafa reynt a\u00f0 m\u00e6la ser\u00f3t\u00f3n\u00edn \u00ed heila d\u00e1inna \u00feunglyndissj\u00faklinga (sj\u00e1lfsmyrtir \u00fear vins\u00e6lastir) og heilbrig\u00f0ra til samanbur\u00f0ar en engar haldb\u00e6rar ni\u00f0urst\u00f6\u00f0ur hafa fengist \u00far svolei\u00f0is; ni\u00f0urst\u00f6\u00f0ur stangast \u00e1. Tilg\u00e1tan stenst enn verr \u00feegar haft er \u00ed huga a\u00f0 margt bendir til a\u00f0 \u00fer\u00edhringlaga \u00feunglyndislyf (t.d. Anafranil) minnki magn noradrenal\u00edns \u00ed heila og \u00e6tti \u00fe.a.l. a\u00f0 valda auknu \u00feunglyndi ef tilg\u00e1tan st\u00e6\u00f0ist.<\/font><\/p>\n

\u00c6 fleiri fr\u00e6\u00f0imenn \u00ed ge\u00f0l\u00e6kningum hafa \u00fev\u00ed dregi\u00f0 \u00feessa einf\u00f6ldu tilg\u00e1tusk\u00fdringu til baka \u00fer\u00e1tt fyrir a\u00f0 henni s\u00e9 \u00e1fram flagga\u00f0 \u00f3spart \u00ed fylgise\u00f0lum lyfja og af \u00edslenskum l\u00e6knum vi\u00f0 s\u00edna sj\u00faklinga, eftir \u00fev\u00ed sem \u00e9g best veit. H\u00e9r eru nefnd tv\u00f6 d\u00e6mi:<\/font>
\n\u00a0<\/p>\n