{"id":446,"date":"2012-10-03T14:00:50","date_gmt":"2012-10-03T14:00:50","guid":{"rendered":"http:\/\/harpa.blogg.is\/2012-10-03\/virka-thunglyndislyf-eda-er-verkunin-adallega-lyfleysuahrif\/"},"modified":"2013-11-21T09:09:29","modified_gmt":"2013-11-21T09:09:29","slug":"virka-thunglyndislyf-eda-er-verkunin-adallega-lyfleysuahrif","status":"publish","type":"post","link":"https:\/\/harpahreins.com\/blogg\/2012\/10\/03\/virka-thunglyndislyf-eda-er-verkunin-adallega-lyfleysuahrif\/","title":{"rendered":"Virka \u00feunglyndislyf e\u00f0a er verkunin a\u00f0allega lyfleysu\u00e1hrif?"},"content":{"rendered":"

\"\u00deunglyndislyf\u00deekktustu ranns\u00f3knir \u00e1 muninum \u00e1 virkni \u00feunglyndislyfja og lyfleysu eru ranns\u00f3knir Irving Kirsch<\/a>. Hann hefur rannsaka\u00f0 lyfleysu\u00e1hrif alla s\u00edna starfs\u00e6vi og er virtur fr\u00e6\u00f0ima\u00f0ur (s\u00e1lfr\u00e6\u00f0ingur a\u00f0 mennt). Af \u00fev\u00ed \u00e9g hef \u00e1\u00f0ur blogga\u00f0 um ranns\u00f3knir og umfj\u00f6llun Kirsch (sj\u00e1 f\u00e6rslurnar M\u00e1ttur lyfleysunnar<\/a> og N\u00fdju lyfin keisarans<\/a>) ey\u00f0i \u00e9g ekki l\u00f6ngu m\u00e1li \u00ed a\u00f0 fjalla um \u00fe\u00e6r. \u00cd hnotskurn s\u00fdna ranns\u00f3knir hans \u00e1 virkni \u00feunglyndislyfja umfram lyfleysu, a\u00f0 munurinn milli verkunar lyfleysu og \u00feunglyndislyfja m\u00e6list \u00e1kaflega l\u00edtill. Fyrstu ni\u00f0urst\u00f6\u00f0ur voru birtar 1998.<\/font><\/p>\n

\u00cd ranns\u00f3knarni\u00f0urst\u00f6\u00f0um \u00ed grein Kirsch o.fl. fr\u00e1 2002<\/a>, sem f\u00f3lst \u00ed yfirfer\u00f0 yfir \u00f6ll g\u00f6gn sem skila\u00f0 var inn til Bandar\u00edska matv\u00e6la- og lyfjaeftirlitsins (FDA) var\u00f0andi tv\u00edblindar ranns\u00f3knir \u00e1 sex algengum \u00feunglyndislyfjum, kemur fram a\u00f0 \u00feeim sj\u00faklingah\u00f3pi sem t\u00f3k virkt \u00feunglyndislyf reyndist batna a\u00f0 vegnu me\u00f0altali um 10,13 stig m\u00e6lt \u00e1 Hamilton-ge\u00f0l\u00e6g\u00f0arkvar\u00f0anum<\/a> en \u00feeim h\u00f3pi sj\u00faklinga sem t\u00f3k lyfleysu batna\u00f0i um 8,24 stig \u00e1 sama kvar\u00f0a a\u00f0 vegnu me\u00f0altali. Af \u00feessum (\u00f6rlitla) mun dr\u00f3 Kirsch \u00fe\u00e1 \u00e1lyktun a\u00f0 82% af m\u00e6ldum bata h\u00f3psins sem t\u00f3k virk \u00feunglyndislyf m\u00e6tti sk\u00fdra me\u00f0 lyfleysu\u00e1hrifum eing\u00f6ngu<\/b>. Sv\u00f6run vi\u00f0 lyfleysu er raunar \u00f3venju mikil \u00ed \u00feunglyndislyfjaranns\u00f3knum mi\u00f0a\u00f0 vi\u00f0 \u00ed lyfjaranns\u00f3knum almennt segir Kirsch \u00ed b\u00f3k sinni The Emperor’s New Drugs<\/i>.<\/font>
\n\u00a0
\n\u00a0<\/p>\n

Munurinn m\u00e6ldist mestur h\u00f3pi \u00feeirra sem voru allra mest \u00feunglyndir (skoru\u00f0u 27 stig e\u00f0a\u00a0h\u00e6rra \u00e1 Hamilton ge\u00f0l\u00e6g\u00f0arkvar\u00f0anum \u00feegar ranns\u00f3kn h\u00f3fst) en hann f\u00f3lst ekki \u00ed \u00fev\u00ed a\u00f0 \u00feeim batna\u00f0i betur af \u00feunglyndislyfjunum heldur \u00ed \u00fev\u00ed a\u00f0 lyfleysan ein og s\u00e9r haf\u00f0i minni bata\u00e1hrif \u00e1 \u00feennan h\u00f3p sj\u00faklinga. \u00dea\u00f0 var einungis \u00ed h\u00f3pi \u00feessara allra veikustu sj\u00faklinga sem munurinn \u00e1 bata \u00feeirra sem t\u00f3ku lyfleysu og \u00feeirra sem t\u00f3ku virkt lyf n\u00e1\u00f0i yfir 3 stig \u00e1 Hamiltonkvar\u00f0anum, sem eru l\u00e1gmarksskilyr\u00f0in sem NICE<\/a> setur fyrir \u00fev\u00ed a\u00f0 bati teljist kl\u00edn\u00edskt markt\u00e6kur <\/b>(n\u00e1nar tilteki\u00f0 m\u00e6ldist munurinn 4,28 stig \u00e1 Hamilton-ge\u00f0l\u00e6g\u00f0arkvar\u00f0anum a\u00f0 vegnu me\u00f0altali). [National Institute of Health and Clinical Excellence er opinber stofnun \u00ed Brelandi, me\u00f0 faglegt og fj\u00e1rhagslegt sj\u00e1lfst\u00e6\u00f0i, en er l\u00edklega oft k\u00f6llu\u00f0 \u201eBresk heilbrig\u00f0isyfirv\u00f6ld\u201c \u00e1 \u00edslensku. Kl\u00edn\u00edskar lei\u00f0beiningar Landsp\u00edtala um \u00feunglyndi og kv\u00ed\u00f0a eru sni\u00f0nar eftir lei\u00f0beiningum NICE.] V\u00edsbendingar eru um a\u00f0 \u00ed sj\u00faklingah\u00f3pi \u00ed raunheimum (clinical practice) s\u00e9 \u00feessi h\u00f3pur ekki st\u00f3r<\/b>, \u00ed fyrirlestri Kirsch \u00ed ma\u00ed 2012<\/a> vitnar hann \u00ed ranns\u00f3kn sem s\u00fdni a\u00f0 um 11% \u00feunglyndissj\u00faklinga sem leita l\u00e6kninga m\u00e6list svo veikur.<\/font><\/p>\n

\u00a0 <\/font>
\nA\u00f0rir hafa endurteki\u00f0 ranns\u00f3knir \u00e1 bor\u00f0 vi\u00f0 ranns\u00f3knir Kirsch og ni\u00f0ursta\u00f0an er s\u00fa sama, \u00fe.e. munur \u00e1 virkni \u00feunglyndislyfja og virkni lyfleysu er einungis kl\u00edn\u00edskt markt\u00e6kur me\u00f0al l\u00edtils h\u00f3ps mj\u00f6g \u00feunglyndra. \u00cd v\u00e6gu e\u00f0a me\u00f0al\u00feungu \u00feunglyndi m\u00e6list l\u00e6kningarm\u00e1ttur lyfleysu og \u00feunglyndislyfja n\u00e1nast s\u00e1 sami. M\u00e1 h\u00e9r nefna:<\/font><\/p>\n

*Ranns\u00f3kn Turner o.fl. fr\u00e1 2008<\/a> (sem voru raunar a\u00f0 rannsaka anna\u00f0, \u00fe.e.a.s. a\u00f0 hve miklu leyti birtar ni\u00f0urst\u00f6\u00f0ur um \u00feunglyndislyfjaranns\u00f3knir v\u00e6ru s\u00e9rvali\u00f0 j\u00e1kv\u00e6tt \u00fartak \u00far ni\u00f0urst\u00f6\u00f0um allra ranns\u00f3kna og birtu \u00feannig skekkta mynd af raunveruleikanum);<\/font><\/p>\n

*Yfirfer\u00f0 Fountoulakis og M\u00fcller 2011<\/a> yfir ranns\u00f3kn og ni\u00f0urst\u00f6\u00f0ur Kirsch sem birtust 2008 (\u00feessir eru svarnir andst\u00e6\u00f0ingar Kirsch, fengu \u00fat n\u00e1nast s\u00f6mu t\u00f6lur \u00ed vegnu me\u00f0altali\u00a0 og Kirsch en hlakka svol\u00edti\u00f0 yfir a\u00f0 finna \u00fat a\u00f0 munur milli lyfleysu og virks lyfs r\u00e9tt slefar yfir 3 stig \u00e1 Hamilton-ge\u00f0l\u00e6g\u00f0arkvar\u00f0anum \u00feegar ni\u00f0urst\u00f6\u00f0ur ranns\u00f3kna \u00e1 venlafaxine [Efexor] og paroxetine [Seroxat] eru sko\u00f0a\u00f0ar s\u00e9rstaklega);<\/font><\/p>\n

*Ranns\u00f3kn Fournier o.fl. 2011<\/a> s\u00fdndi enn minni mun \u00e1 lyfleysu og virku lyfi en Kirsch haf\u00f0i fundi\u00f0 \u00fat. \u00deeir settu strangari skilyr\u00f0i en Kirsch, t\u00f3ku t.d. einungis til greina tv\u00edblindar ranns\u00f3knir sem grisju\u00f0u ekki \u00far sj\u00faklinga sem sv\u00f6ru\u00f0u lyfleysu \u00ed fyrstu e\u00f0a annarri viku ranns\u00f3knar (\u201ewashout period\u201c er \u00feetta kalla\u00f0, \u00fe.e. oft er \u00f6llum \u00fe\u00e1tttakendum \u00ed svona lyfjaranns\u00f3knum gefin lyfleysa \u00ed fyrstu vikunni\/fyrstu tv\u00e6r vikurnar og \u00feeir sem s\u00fdna strax j\u00e1kv\u00e6\u00f0a sv\u00f6run eru reknir \u00far ranns\u00f3kninni) og \u00feeir fengu \u00f6ll frumg\u00f6gn um einstaka \u00fe\u00e1tttakendur afhent. A\u00f0 uppfylltum \u00feessum str\u00f6ngu skilyr\u00f0um st\u00f3\u00f0u eftir 6 ranns\u00f3knir me\u00f0 718 \u00fe\u00e1tttakendum. Fournier og f\u00e9lagar l\u00fdsa \u00fev\u00ed yfir a\u00f0 af \u00fev\u00ed \u201ewashout\u201ca\u00f0fer\u00f0in var notu\u00f0 \u00ed \u00f6llum ranns\u00f3knunum sem Kirsch sko\u00f0a\u00f0i s\u00fdni ni\u00f0urst\u00f6\u00f0ur hans minna v\u00e6gi lyfleysu en \u00fea\u00f0 raunverulega er. Ni\u00f0ursta\u00f0a \u00feeirra er nokku\u00f0 afdr\u00e1ttarlaus: \u201e[M\u00e6lanlegur bati af \u00feunglyndislyfjum] … er l\u00edklega hverfandi e\u00f0a enginn hj\u00e1 sj\u00faklingum me\u00f0 v\u00e6gt e\u00f0a me\u00f0al\u00feungt \u00feunglyndi. Fyrir mj\u00f6g veika \u00feunglyndisj\u00faklinga er \u00e1vinningur af lyfjum umfram lyfleysu talsver\u00f0ur.\u201c<\/font>
\n\u00a0<\/p>\n

V\u00ed\u00f0a hefur komi\u00f0 fram a\u00f0 lyfjafyrirt\u00e6ki hafa vali\u00f0 vandlega\u00a0 \u00far ranns\u00f3knum\/ranns\u00f3knarni\u00f0ust\u00f6\u00f0ur og birta einungis j\u00e1kv\u00e6\u00f0ar ni\u00f0urst\u00f6\u00f0ur. \u00deunglyndislyfjaranns\u00f3knir \u00fear sem bati af lyfleysu m\u00e6list jafnmikill og af lyfinu sem veri\u00f0 er a\u00f0 pr\u00f3fa eru ekki birtar opinberlega. Hinar s\u00e9rv\u00f6ldu ranns\u00f3knir sem birtar eru hafa svo or\u00f0i\u00f0 uppspretta fj\u00f6lda greina ge\u00f0l\u00e6kna og fr\u00e6\u00f0imanna sem byggja \u00e1 \u00feeim, grunlausir um a\u00f0rar ranns\u00f3knarni\u00f0urst\u00f6\u00f0ur \u00ed s\u00f6mu lyfjapr\u00f3funum. Raunar hefur l\u00edka veri\u00f0 s\u00fdnt fram \u00e1 a\u00f0 \u00f3tr\u00falega margir byggja umfj\u00f6llun s\u00edna \u00e1 \u00f3tr\u00falega f\u00e1um ranns\u00f3knum. S\u00fa mynd sem f\u00e6st af gagnsemi \u00feunglyndislyfja me\u00f0 lestri fr\u00e6\u00f0irita er \u00fev\u00ed verulega skekkt. (Benda m\u00e1 \u00e1 ni\u00f0urst\u00f6\u00f0ur Turner o.fl. 2008<\/a> og grein Ioannidis 2008<\/a> sem d\u00e6mi um \u00feennan m\u00e1lflutning en raunar vekja n\u00e1nast allir sem skrifa gagnr\u00fdni\u00f0 um \u00feunglyndislyfjaranns\u00f3knir og lyfjafyrirt\u00e6ki athygli \u00e1 \u00feessu.)<\/font>
\n\u00a0<\/font>
\n\u00a0<\/font>
\n\u00a0
\n\u00a0<\/p>\n

Gagnr\u00fdni e\u00f0a andsv\u00f6r vi\u00f0 ranns\u00f3knarni\u00f0urst\u00f6\u00f0um sem s\u00fdna a\u00f0 virkni \u00feunglyndislyfja m\u00e6list mj\u00f6g l\u00edti\u00f0 meiri en virkni lyfleysu<\/font><\/b>
\n\u00a0<\/p>\n

Kirsch hefur s\u00e6tt \u00f3v\u00e6ginni gagnr\u00fdni fyrir ranns\u00f3knarni\u00f0urst\u00f6\u00f0ur s\u00ednar, sem og sporg\u00f6ngumenn hans. \u00cd fyrri tveimur f\u00e6rslum m\u00ednum um ranns\u00f3knir Kirsch,\u00a0 M\u00e1ttur lyfleysunnar<\/a> og N\u00fdju lyfin keisarans<\/a>, ger\u00f0i \u00e9g grein fyrir hluta gagnr\u00fdninnar og endurtek ekki h\u00e9r. Yfirlit yfir helstu atri\u00f0i sem hafa veri\u00f0 gagnr\u00fdnd m\u00e1 sj\u00e1 \u00ed grein Fountoulakis og M\u00fcller 2011<\/a> en \u00feeir telja upp (og v\u00edsa \u00ed heimildir):<\/font><\/p>\n

* A\u00f0st\u00e6\u00f0ur og sj\u00faklingah\u00f3par \u00ed slembdri kl\u00edn\u00edskri pr\u00f3fun (randomized clinical trial) endurspegla ekki a\u00f0st\u00e6\u00f0ur \u00ed raunheimi;<\/font>
\n* \u00cd raunverulegum a\u00f0st\u00e6\u00f0um t\u00ed\u00f0kast a\u00f0 efla virkni \u00feunglyndislyfja me\u00f0 annarri me\u00f0fer\u00f0 samhli\u00f0a (t.d. \u00f6\u00f0rum lyfjum);<\/font>
\n* \u00ddmislegt m\u00e1 a\u00f0 Hamilton-kvar\u00f0anum finna og \u00fe\u00e1ttakendur \u00ed slembdum kl\u00edn\u00edskum pr\u00f3funum taka oft \u00f6nnur lyf sem hafa mikil \u00e1hrif \u00e1 sum atri\u00f0i kvar\u00f0ans, t.d. bens\u00f3dr\u00ednlyf;<\/font>
\n* \u00dea\u00f0 er rangt a\u00f0 t\u00falka l\u00e6kningarm\u00e1tt \u00feunglyndislyfja eing\u00f6ngu me\u00f0 \u00fev\u00ed a\u00f0 sko\u00f0a muninn \u00e1 bata af lyfjat\u00f6ku og bata af lyfleysu.<\/font><\/p>\n

Hva\u00f0 var\u00f0ar s\u00ed\u00f0astt\u00f6ldu r\u00f6kin er r\u00f6kstu\u00f0ningur \u00feeirra Fountoulakis og M\u00fcller eitthva\u00f0 \u00e1 \u00feessa lei\u00f0:<\/font><\/p>\n

Af \u00fev\u00ed lyfleysu\u00e1hrif m\u00e6last minni hj\u00e1 veikustu \u00feunglyndissj\u00faklingunum en \u00e1hrif \u00feunglyndislyfja m\u00e6last jafnmikil [\u00f6llu heldur jafnl\u00edtil] hj\u00e1 \u00f6llum h\u00f3pum m\u00e1 draga \u00fe\u00e1 \u00e1lyktun a\u00f0 v\u00e6nting um sv\u00f6run (response expectancy) st\u00fdri lyfleysu\u00e1hrifum en ekki \u00e1hrifum \u00feunglyndislyfja. \u00c1hrif\/verkun lyfjanna s\u00e9u \u00fev\u00ed sannanleg og ekki h\u00e1\u00f0 \u00fev\u00ed hve illa haldnir \u00fe\u00e1ttakendur \u00ed tilraununum eru \u00fev\u00ed \u00e1hrif lyfleysunnar stafa af \u00f6\u00f0rum ors\u00f6kum. \u00deeir b\u00e6ta \u00fev\u00ed svo vi\u00f0 a\u00f0 gildi slembdra kl\u00edn\u00edskra pr\u00f3fana kunni a\u00f0 vera vafasamt \u00fat af \u00feessu.<\/font><\/p>\n

\u00deeir sem leggja \u00e1herslu \u00e1 a\u00f0 ranns\u00f3knarumhverfi \u00ed kl\u00edn\u00edskum \u00feunglyndislyfjaranns\u00f3knum endurspegli ekki raunveruleikann hafa til skamms t\u00edma hampa\u00f0 mj\u00f6g ni\u00f0urst\u00f6\u00f0um \u00far STAR*D ranns\u00f3kninni<\/a> til s\u00f6nnunar \u00feess a\u00f0 langt\u00edmame\u00f0fer\u00f0 me\u00f0 \u00feunglyndislyfjum, einkum me\u00f0 annarri lyfjagj\u00f6f, s\u00fdni g\u00f3\u00f0an \u00e1rangur.\u00a0\u00deetta var risast\u00f3r amer\u00edsk langt\u00edmaranns\u00f3kn \u00e1 raunverulegum \u00feunglyndissj\u00faklingum \u00ed raunumhverfi. Ef eitt \u00feunglyndislyf virka\u00f0i ekki var b\u00e6tt vi\u00f0 fleiri me\u00f0fer\u00f0arkostum, a\u00f0allega lyfjum en einnig gafst kostur \u00e1 s\u00e1lfr\u00e6\u00f0ime\u00f0fer\u00f0 (a\u00f0allega hugr\u00e6nni atferlisme\u00f0fer\u00f0). Ranns\u00f3knin var \u00ferepaskipt, \u00fe.e. sko\u00f0u\u00f0 voru fj\u00f6gur \u00ferep mismunandi me\u00f0fer\u00f0a. Lyfleysa var hvergi notu\u00f0 til samanbur\u00f0ar. Pigott o.fl. birtu grein \u00e1ri\u00f0 2010<\/a> \u00fear sem s\u00fdnt er fram \u00e1 a\u00f0 birtum ranns\u00f3knarni\u00f0urst\u00f6\u00f0um \u00far STAR*D var talsvert hagr\u00e6tt: \u00dev\u00ed haf\u00f0i t.d. veri\u00f0 flagga\u00f0 mj\u00f6g\u00a0a\u00f0 67% sj\u00faklinga hafi batna\u00f0 v\u00e6ri \u00e1rangur \u00e1 \u00f6llum me\u00f0fer\u00f0ar\u00ferepum lag\u00f0ur saman (37% batna\u00f0i af fyrsta lyfi, 19% \u00e1 n\u00e6sta me\u00f0fer\u00f0ar\u00ferepi, 6% \u00e1 \u00fev\u00ed \u00feri\u00f0ja og 5% \u00e1 fj\u00f3r\u00f0a \u00ferepi). \u00deess var hins vegar ekki geti\u00f0 a\u00f0 93% \u00feeirra sem n\u00e1\u00f0u bata af einhverri \u00feessara fj\u00f6gurra \u00ferepaskiptu me\u00f0fer\u00f0 veiktust aftur innan \u00e1rs e\u00f0a h\u00e6ttu \u00ed ranns\u00f3kninni.\u00a0<\/font>
\n\u00a0<\/p>\n

\u00cd svari vi\u00f0 grein Ioannidis sem birtist \u00ed 2011, eftir Davis o.fl<\/a>. er teki\u00f0 undir a\u00f0 slembdar kl\u00edn\u00edskar pr\u00f3fanir endurspegli ekki raunveruleikann, \u00feekking l\u00e6knis \u00e1 sj\u00faklingi og sj\u00fakras\u00f6gu hans vegi svo \u00feungt a\u00f0 hann geti vali\u00f0 \u00feunglyndislyf sem gagnist \u00fe\u00f3tt tilraunirnar hafi ekki s\u00fdnt fram \u00e1 m\u00e6lanlegan \u00e1rangur af \u00feeim; a\u00f0 tilraunirnar n\u00fa til dags s\u00e9u ger\u00f0ar \u00e1 f\u00f3lki sem svari augl\u00fdsingum og \u00feiggi laun fyrir, \u00fea\u00f0 f\u00f3lk kunni a\u00f0 hir\u00f0a bara launin s\u00edn og sleppa \u00fev\u00ed a\u00f0 taka lyfin sem skekki ni\u00f0urst\u00f6\u00f0urnar; a\u00f0rar vi\u00f0urkenndar l\u00e6knisa\u00f0fer\u00f0ir s.s. skur\u00f0l\u00e6kningar eru ekki studdar tv\u00edblindum ranns\u00f3knum og m\u00e6tti allt eins beina spj\u00f3tum s\u00ednum a\u00f0 \u00feeim; a\u00f0 \u00fea\u00f0 hafi \u00fer\u00e1tt fyrir allt veri\u00f0 s\u00fdnt fram \u00e1 m\u00e6lanlegan mun \u00e1 bata \u00e1kve\u00f0ins sj\u00faklingah\u00f3ps af \u00feunglyndislyfjum samanbori\u00f0 vi\u00f0 lyfleysu sem s\u00fdni a\u00f0 \u00feunglyndislyf virki.<\/font><\/p>\n

\"ProzacHva\u00f0 var\u00f0ar meintan \u00f3hei\u00f0arleika sumra sem taka \u00fe\u00e1tt \u00ed \u00feunglyndislyfjaranns\u00f3knum tekur Peter D. Kramer \u00ed sama streng \u00ed grein sem birtist \u00ed New York Times<\/i><\/a> sumari\u00f0 2011. Hann b\u00e6tir ennfremur vi\u00f0 a\u00f0 einhverjum \u00fe\u00e1tttakendum \u00ed svona ranns\u00f3kn g\u00e6ti hreinlega hafa batna\u00f0 af sj\u00e1lfu s\u00e9r sem hafi ekkert me\u00f0 lyfleysu\u00e1hrif a\u00f0 gera en skekki ni\u00f0urst\u00f6\u00f0ur. (Kramer n\u00e1\u00f0i heimsfr\u00e6g\u00f0 me\u00f0 b\u00f3kinni Listening to Prozac<\/i> sem kom \u00fat 1993. Hann er pr\u00f3fessor \u00ed ge\u00f0l\u00e6knisfr\u00e6\u00f0um vi\u00f0 H\u00e1sk\u00f3lann \u00ed Brown.)<\/font><\/p>\n

\u00cd yfirl\u00fdsingu Evr\u00f3psku ge\u00f0l\u00e6knasamtakanna um gagnsemi \u00feunglyndislyfja<\/a> sem birt var \u00ed \u00e1r, 2012, er talsver\u00f0u p\u00fa\u00f0ri eytt \u00e1 gagnr\u00fdni \u00e1 ranns\u00f3knir Kirsch og sporg\u00f6ngumanna. (\u00deetta plagg er raunar svo merkilegt a\u00f0 \u00e9g spl\u00e6si s\u00e9rstakri f\u00e6rslu um \u00fea\u00f0 s\u00ed\u00f0ar.) \u00dear segir m.a. a\u00f0:<\/font><\/p>\n

* \u00de\u00f3tt munur \u00e1 l\u00e6kningarm\u00e6tti \u00feunglyndislyfja og lyfleysu n\u00e1i ekki a\u00f0 vera kl\u00edn\u00edskt markt\u00e6kur s\u00e9 hann t\u00f6lfr\u00e6\u00f0ilega markt\u00e6kur \u00fev\u00ed Kirsch hafi byggt \u00e1 svo fj\u00f6lmennu gagnasafni. [Kirsch \u00fatsk\u00fdrir \u00e1kaflega vel hver munurinn \u00e1 \u00feessum tveimur hugt\u00f6kum er \u00ed fyrirlestri sem kr\u00e6kt er \u00ed \u00far heimildalista ne\u00f0st \u00ed f\u00e6rslunni];<\/font><\/p>\n

* NICE skilyr\u00f0in um a\u00f0 kl\u00edn\u00edskt markt\u00e6kur munur \u00feurfi a\u00f0 vera a\u00f0 l\u00e1gmarki 3 batastig \u00e1 Hamilton-ge\u00f0l\u00e6g\u00f0arkvar\u00f0anum eru valin af handah\u00f3fi en ekki studd v\u00edsindalegum g\u00f6gnum. \u00dar \u00fev\u00ed Bandar\u00edska matv\u00e6la- og lyfjaeftirlitsstofnunin og Evr\u00f3pska lyfjaeftirlitsstofnunin hefur veitt leyfi fyrir \u00feeim lyfjum sem ekki n\u00e1 \u00feessum l\u00e1gmarksskilyr\u00f0um \u00e6tti a\u00f0 l\u00e6kka l\u00e1gmarksskilyr\u00f0in. [\u00cd \u00feessu sambandi m\u00e1 geta a\u00f0 Kirsch og margir fleiri hafa bent \u00e1 a\u00f0 leyfi \u00feessara stofnana hafa veri\u00f0 veitt \u00e1 grundvelli s\u00e9rstaks \u00farvals j\u00e1kv\u00e6\u00f0ra ni\u00f0ursta\u00f0na \u00far fj\u00f6lda ranns\u00f3kna, \u00fe.e. a\u00f0 \u00fe\u00e6r ranns\u00f3knir sem s\u00fdndu l\u00edtinn e\u00f0a engan mun \u00e1 \u00e1hrifum lyfleysu og \u00feunglyndislyfja voru ekki taldar fram – engin takm\u00f6rk eru \u00e1 hve margar ranns\u00f3knir lyfjafyrirt\u00e6ki megi l\u00e1ta framkv\u00e6ma og einungis \u00fearf a\u00f0 s\u00fdna fram \u00e1 kl\u00edn\u00edskt markt\u00e6kan mun \u00ed tveimur ranns\u00f3knum];<\/font><\/p>\n

* Af ofans\u00f6g\u00f0u megi draga \u00fe\u00e1 \u00e1lyktun a\u00f0 a\u00f0 bati sem m\u00e6list um 2 stig \u00e1 Hamilton-ge\u00f0l\u00e6g\u00f0arkvar\u00f0anum s\u00e9 raunverulega kl\u00edn\u00edskt markt\u00e6kur;<\/font><\/p>\n

* \u00de\u00f3tt vegi\u00f0 me\u00f0altal s\u00fdni l\u00edtinn l\u00e6kningam\u00e1tt \u00feunglyndislyfja segi sl\u00edkt ekkert um l\u00e6kningarm\u00e1tt fyrir vissa sj\u00faklingah\u00f3pa e\u00f0a einstaklinga;<\/font><\/p>\n

* \u00cd raunverulegum a\u00f0st\u00e6\u00f0um er venjulega beitt samsettri me\u00f0fer\u00f0 vi\u00f0 \u00feunglyndi (\u00ed yfirl\u00fdsingunni er annars sta\u00f0ar eindregi\u00f0 m\u00e6lt me\u00f0 samsettri lyfjagj\u00f6f fremur en annarri me\u00f0fer\u00f0) og ranns\u00f3knir sem m\u00e6la virkni eins lyfs \u00e1 \u00feunglyndissj\u00faklinga gefi \u00fev\u00ed skekkta mynd af l\u00e6kningarm\u00e6tti \u00feess (\u00ed yfirl\u00fdsingunni kemur annars sta\u00f0ar fram a\u00f0 einungis um 30% \u00feunglyndra sj\u00faklinga \u00ed raunverulegum a\u00f0st\u00e6\u00f0um hlj\u00f3ti einhvern bata af einu \u00feunglyndislyfi);<\/font><\/p>\n

* Ranns\u00f3knirnar sem Kirsch greindi voru allar skammt\u00edmaranns\u00f3knir, st\u00f3\u00f0u \u00ed h\u00e6sta lagi \u00ed 8 vikur. A\u00f0rar ranns\u00f3knir \u00e1 langt\u00edmalyfjagj\u00f6f s\u00fdna meiri mun \u00e1 bata af lyfleysu og \u00feunglyndislyfjum. V\u00edsa\u00f0 er \u00ed ni\u00f0urst\u00f6\u00f0ur einnar safnranns\u00f3knar, framkv\u00e6md af Geddes o.fl., sem birtust \u00e1ri\u00f0 2003<\/a> \u00feessu til stu\u00f0nings. \u00cd henni voru sko\u00f0a\u00f0ar ranns\u00f3knir \u00e1 f\u00f3lki sem haf\u00f0i s\u00fdnt sv\u00f6run vi\u00f0 \u00feunglyndislyfjagj\u00f6f \u00ed stuttri ranns\u00f3kn og sko\u00f0a\u00f0 hversu mikill munur v\u00e6ri \u00e1 \u00fev\u00ed hvort \u00feeir sem h\u00e9ldu \u00e1fram a\u00f0 taka lyfin \u00ed lengri t\u00edma og \u00feeir sem voru l\u00e1tnir h\u00e6tta \u00e1 lyfinu og settir \u00e1 lyfleysu \u00ed sta\u00f0inn veiktust aftur. A\u00f0 me\u00f0altali veiktust 41% \u00feeirra sem teknir voru af \u00feunglyndislyfinu og gefin lyfleysa \u00ed sta\u00f0inn, 18% \u00feeirra sem h\u00e9ldu \u00e1fram a\u00f0 taka \u00feunglyndislyf \u00ed lengri t\u00edma veiktust.;<\/font><\/p>\n

* \u00dea\u00f0 er hvort sem er si\u00f0fer\u00f0ilega rangt a\u00f0 gefa sj\u00faklingi lyfleysu \u00e1n \u00feess a\u00f0 hann viti \u00fea\u00f0 og gagnslaust a\u00f0 \u00e1v\u00edsa sj\u00faklingi lyfleysu sem hann veit a\u00f0 er lyfleysa. [Kirsch hefur reyndar gert sl\u00edka tilraun sem skila\u00f0i m\u00e6lanlegum bata, sj\u00e1 fyrirlestur hans \u00ed heimildaskr\u00e1.] \u00de.a.l. s\u00e9 ekki annar kostur en treysta \u00e1 lyf en ekki lyfleysu \u00ed raunverulegum a\u00f0st\u00e6\u00f0um.<\/font>
\n\u00a0<\/p>\n

Ni\u00f0ursta\u00f0an er s\u00fa a\u00f0 \u00fea\u00f0 er \u00f3umdeilt a\u00f0 \u00ed \u00feunglyndislyfjatilraunum m\u00e6list s\u00e1ral\u00edtill munur \u00e1 l\u00e6kningarm\u00e6tti lyfleysu og lyfja. Helst m\u00e6list munur hj\u00e1 f\u00e1rveikum \u00feunglyndissj\u00faklingum vegna \u00feess a\u00f0 lyfleysa virkar s\u00ed\u00f0ur \u00e1 \u00feann sj\u00faklingah\u00f3p. Menn greinir hins vegar \u00e1 um hvernig beri a\u00f0 t\u00falka \u00feessar ni\u00f0urst\u00f6\u00f0ur og af hverju \u00fe\u00e6r kunni a\u00f0 stafa.<\/font><\/b>
\n\u00a0<\/p>\n

N\u00e6sta f\u00e6rsla fjallar um aukaverkanir og m\u00f6guleg ska\u00f0leg \u00e1hrif sem \u00feunglyndislyf geta haft. Svo helga \u00e9g yfirl\u00fdsingu Evr\u00f3psku ge\u00f0l\u00e6knasamtanna um \u00feunglyndislyf eina f\u00e6rslu.<\/font>
\n\u00a0<\/p>\n

Efri myndin \u00ed \u00feessari f\u00e6rslu er af fors\u00ed\u00f0u Newsweek <\/i>8. febr\u00faar 2010. Ne\u00f0ri myndin er af fors\u00ed\u00f0u sama t\u00edmarits 26. mars 1990.<\/font>
\n\u00a0<\/font>
\n\u00a0<\/font>
\n\u00a0<\/p>\n

Heimildir<\/font><\/b>
\n\u00a0<\/p>\n

Davis o.fl. 2011. Should We Treat Depression with drugs or psychological interventions? A Reply to Ioannidis<\/a>. Philosophy, Ethics, and Humanities in Medicine<\/i> 2011, 6:8.<\/font><\/p>\n

Fountoulakis og M\u00f6ller. 2011. Efficacy of antidepressants: a re-analysis and re-interpretation of the Kirsch data<\/a>. The International Journal of Neuropsychopharmacology<\/i> 14:3 s. 405-12.<\/font>
\nMj\u00f6g svipa\u00f0a grein eftir \u00fe\u00e1 tvo m\u00e1 finna undir heitinu Antidepressant drugs and the response in the placebo group: the real problem lies in our understanding of the issue<\/a> \u00ed Journal of\u00a0 Psychopharmacology<\/i> 2012 26:744.<\/font><\/p>\n

Fournier o.fl.2010.\u00a0 Antidepressant Drug Effects and Depression Severity. A Patient-Level Meta-analysis<\/a>. The Journal of American Medical Association<\/i> (JAMA) 2010;303(1).<\/font><\/p>\n

Geddes o.fl. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review<\/a>. The Lancet<\/i> 22. febr\u00faar 2003.<\/font><\/p>\n

Ioannidis. 2008. Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?<\/a> Philosophy, Ethics, and Humanities in Medicine<\/i> 2008, 3:14.<\/font><\/p>\n

Kirsch. 2012.\u00a0 Placebo Therapy as an Ethical Alternative<\/a>, fyrirlestur me\u00f0 gl\u00e6rum fluttur \u00e1 \u00feingi The Consortium of Academic Health Centers for Integrative Medicine \u00feann 16. ma\u00ed 2012.<\/font><\/p>\n

Kirsch. 2011. Antidepressants and the Placebo Response \u00ed De-Medicalizing Misery. Psychiatry, Psychology and the Human Condition<\/i>, s. 187-196. Palgrave Macmillan.<\/font><\/p>\n

Kirsch. 2010. The Emeror’s New Drugs<\/i>. Basic Books New York. [Kom fyrst \u00fat 2009.]<\/font><\/p>\n

Kirsch o.fl. 2008. Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration<\/a>. Febr\u00faarhefti PLOS Medicine<\/i> 2008.<\/font><\/p>\n

Kirsch o.fl. 2002. The Emperor’s New Drugs: An Analysis of Antidepressant Medication Data Submitted to the US Food and Drug Administration<\/a>. Prevention & Treatment<\/i>, 5. \u00e1rg. 2002 s. 1522-1534.<\/font><\/p>\n

Kramer, Peter D. 2011. In Defense of Antidepressants<\/a>. New York Times<\/i> 9. j\u00fal\u00ed 2011.<\/font><\/p>\n

M\u00f6ller o.fl. 2012.\u00a0Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression<\/a>. European Psychiatry<\/i> 27:2 s, 114\u2013128<\/font><\/p>\n

Pigott o.fl. 2010.\u00a0Efficacy and Effectiveness of\u00a0 Antidepressants: Current Status of\u00a0 Research<\/a>.\u00a0 Psychotherapy and\u00a0 Psychosomatics<\/i> 2010;79 s. 267\u2013279.<\/font><\/p>\n

Turner o.fl. 2008. Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy.<\/a> The New England Journal of Medicine<\/i> 2008; 358:252-260.<\/font>
\nFylgiskjal greinarinnar me\u00f0 t\u00f6lfr\u00e6\u00f0ilegum uppl\u00fdsingum er h\u00e9r<\/a>.<\/font>
\n\u00a0
\n\u00a0
\n\u00a0
\n\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"

\u00deekktustu ranns\u00f3knir \u00e1 muninum \u00e1 virkni \u00feunglyndislyfja og lyfleysu eru ranns\u00f3knir Irving Kirsch. Hann hefur rannsaka\u00f0 lyfleysu\u00e1hrif alla s\u00edna starfs\u00e6vi og er virtur fr\u00e6\u00f0ima\u00f0ur (s\u00e1lfr\u00e6\u00f0ingur a\u00f0 mennt). Af \u00fev\u00ed \u00e9g hef \u00e1\u00f0ur blogga\u00f0 um ranns\u00f3knir …<\/span> Read More …<\/span><\/a><\/span><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[11],"tags":[],"class_list":["post-446","post","type-post","status-publish","format-standard","hentry","category-gedlyf"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts\/446","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/comments?post=446"}],"version-history":[{"count":1,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts\/446\/revisions"}],"predecessor-version":[{"id":639,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts\/446\/revisions\/639"}],"wp:attachment":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/media?parent=446"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/categories?post=446"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/tags?post=446"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}