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Virker psykofarmaka?

Psykofarmaka virker, men de virker sjelden mot lidelsene de skal motvirke.

Norske studier har vist at mellom 37 og 54 prosent av voksne med utviklingshemming blir behandlet med psykotrope legemidler i den kommunale omsorgen, i følge Anne Marit Bygdnes. Forholdet har vært kjent lenge og alle med kjennskap til feltet mener at alt for mange medisineres mot sykdommer de ikke har. Blant dem som har diagnoser, er det også mye som tyder på for mye pilletrilling.

– Årsaka er at me manglar kompetanse til å vurdera helsesituasjonen til psykisk utviklingshemma. Me kan sjå at mistrivsel blir feiltolka som psykiatrisk sjukdom, sa daværende assisterende helsedirektør Bjørn Guldvåg til NRK i 2011.

–Av og til må nokon dopast ned, var Stavangerlegen og kommunepolitikeren Kåre Reitens kommentar.

Det er ingen grunn til å betvile at mange medisineres mot lidelser som de ikke har. Men om en har psykose eller depresjon, så blir en sannsynligvis heller ikke bedre av medisinene.

I følge Paulsrudutvalget (side 111), må en gi medikamentell behandling til mellom 5 og 10 pasienter med psykose for at en pasient skal bli bedre (Number Needed to Treat).

Legetidsskriftet The Lancet publiserte i 2018 en omfattende effektundersøkelse av antidepressiva. Artikkelen bygger på 522 vitenskapelige studier som har undersøkt effekten av antidepressiva ved moderat til alvorlig depresjon blant 116.477 forsøkspersoner. Av legemidlene som inngikk i undersøkelsen var amitriptylin det mest effektive, mens reboxetin var det minst effektive. Effektene var imidlertid små. Ut i fra de oppgitte effektene, så må en behandle minst 6 pasienter for å registrere forbedring hos en (Number Needed to Treat), når det gjelder amitriptylin. For reboxetin, må en behandle minst 13 pasienter for at en skal få forbedring (Number Needed to Treat).

Jeg kjenner ikke til kontrollerte effektundersøkelser av medisinene overfor mennesker med utviklingshemming. Usikkerheten knyttet til effektene er derfor større. I den grad medisinene medfører forvirring eller redusert kognisjon, kan en anta at de negative konsekvensene av medisineringen er større for mennesker med utviklingshemming enn de fleste andre grupper.

Om en bør ta medisiner mot sykdommer som en ikke har eller om en bør ta medisiner som sannsynligvis ikke virker, må den enkelte pasient avgjøre. Om medisineringspraksisen er faglig forsvarlig overfor mennesker med utviklingshemming som ikke kan gi informert samtykke, burde Helsedirektoratet hatt en mening om.

Jens Petter Gitlesen

1 juli 2019

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