Niv\u00e5erna av dopamin och placeboeffekten kan avg\u00f6ra om patienter med social \u00e5ngest f\u00f6rb\u00e4ttras eller inte vid medicinering med SSRI. En ny studie visar att hos patienter som hade en positiv f\u00f6rv\u00e4ntan p\u00e5 medicineringen var effekten fyra g\u00e5nger s\u00e5 h\u00f6g som hos patienter som hade en l\u00e5g f\u00f6rv\u00e4ntan. Det trots att b\u00e5de grupperna fick samma medicinska behandling. Trots att SSRI p\u00e5verkar niv\u00e5erna av serotonin i hj\u00e4rnan var det effekterna p\u00e5 dopamin som hade st\u00f6rst betydelse f\u00f6r f\u00f6rb\u00e4ttring.<\/strong><\/h5>\n\n\n\n
Vid depression och \u00e5ngest \u00e4r SSRI (selektiva serotonin\u00e5terupptagsh\u00e4mmare) etablerade, effektiva l\u00e4kemedel. Men placeboeffekten, att den positiva effekten av en behandling blir st\u00f6rre n\u00e4r patienten f\u00f6rv\u00e4ntar sig att bli hj\u00e4lpt, \u00e4r ett v\u00e4lk\u00e4nt fenomen. Den kan vara stark och det \u00e4r oklart hur mycket av f\u00f6rb\u00e4ttringen som beror p\u00e5 f\u00f6rv\u00e4ntningar vid SSRI-behandling. Det \u00e4r ocks\u00e5 oklart om f\u00f6rv\u00e4ntningar utnyttjar samma mekanism i hj\u00e4rnan som SSRI-preparaten, att h\u00e4mma transport\u00f6rproteinet f\u00f6r serotonin, eller om andra signal\u00e4mnen \u00e4r inblandade. Den nya studien tyder p\u00e5 att det \u00e4r transport\u00f6rproteinet f\u00f6r dopamin som \u00e4r nyckeln.<\/p>\n\n\n\n
Placeboeffekten stark<\/h6>\n\n\n\n
I en studie av social \u00e5ngest, publicerad i Translational Psychiatry,<\/em> kunde forskare vid Uppsala universitet bekr\u00e4fta att placeboeffekten var stark n\u00e4r det g\u00e4ller den \u00e5ngestd\u00e4mpande effekten av SSRI-medlet escitalopram<\/em>. Det \u00f6verraskande med studien \u00e4r att f\u00f6rb\u00e4ttringen efter SSRI-behandlingen till stor del kan knytas till effekter p\u00e5 dopamin snarare \u00e4n serotonintransport\u00f6rerna.<\/p>\n\n\n\nI studien behandlades alla deltagare med social \u00e5ngest med samma kliniska dos av det verksamma medlet escitalopram<\/em> under nio veckor. Men de hade olika f\u00f6rv\u00e4ntningar. H\u00e4lften fick korrekt information om l\u00e4kemedlet och dess effektivitet medan en \u201ccover story\u201d anv\u00e4ndes f\u00f6r den andra h\u00e4lften. Deltagarna blev d\u00e5 informerade om, att medlet var en s\u00e5 kallad \u201daktiv placebo\u201d. Den skulle ge liknande biverkningar som SSRI men inte hj\u00e4lpa mot deras sociala \u00e5ngest.<\/p>\n\n\n\nKorrekt information f\u00f6rb\u00e4ttrar h\u00e4lsan<\/h6>\n\n\n\n
\u2013 Resultaten visade att andelen som blev b\u00e4ttre av behandlingen var n\u00e4ra fyra g\u00e5nger h\u00f6gre n\u00e4r patienterna fick korrekt information. Det st\u00e4mmer med tidigare forskning att f\u00f6rv\u00e4ntningar p\u00e5verkar behandlingsutfallet, s\u00e4ger forskaren Olof Hjorth.<\/p>\n\n\n\n
I unders\u00f6kningar med PET-scanner (positronemissionstomografi) kunde forskarna se att SSRI-medlet gav samma effekt p\u00e5 serotoninet i de b\u00e5da grupperna och hade blockerat omkring 80 procent av serotonintransport\u00f6rerna. Det g\u00e4llde allts\u00e5 \u00e4ven den grupp som hade l\u00e5ga f\u00f6rv\u00e4ntningar och som inte blev b\u00e4ttre.<\/p>\n\n\n\n
\u2013 Det tyder p\u00e5 att den farmakologiska effekten av SSRI var identisk i b\u00e5da grupperna och att den inte kan f\u00f6rklara varf\u00f6r korrekt information gav b\u00e4ttre behandlingseffekt. Det r\u00e4cker allts\u00e5 inte med att h\u00e4mma serotonintransport\u00f6rerna f\u00f6r att SSRI-medel ska kunna lindra social \u00e5ngest, s\u00e4ger Olof Hjorth.<\/p>\n\n\n\n
F\u00f6rv\u00e4ntningar p\u00e5verkar fris\u00e4ttningen av dopamin<\/h6>\n\n\n\n
En tydlig skillnad mellan grupperna kunde ist\u00e4llet ses n\u00e4r transport\u00f6rproteinet f\u00f6r dopamin blev m\u00e4tt efter behandlingen. De deltagare som gick in i behandlingen med vetskap om att det var ett verksamt l\u00e4kemedel hade f\u00e4rre fria dopamintransport\u00f6rer i striatum, en del av storhj\u00e4rnan. Effekten gick i motsatt riktning i den grupp som hade blivit informerad med cover storyn. En f\u00f6rklaring kan vara att f\u00f6rv\u00e4ntningar p\u00e5verkar dopaminfris\u00e4ttningen i hj\u00e4rnans bel\u00f6ningsn\u00e4tverk. Det skapar skillnader i andelen lediga dopamintransport\u00f6rer efter behandling i de tv\u00e5 grupperna.<\/p>\n\n\n\n
\u2013 Resultaten tyder p\u00e5 att positiva f\u00f6rv\u00e4ntningar, som uppst\u00e5r i relationen mellan l\u00e4kare och patient, p\u00e5verkar dopamin och f\u00f6rst\u00e4rker effekten av SSRI-behandling, s\u00e4ger professor Tomas Furmark, som ledde studien.<\/p>\n\n\n\n
Foto:<\/strong> Pixabay<\/p>\n\n\n\n<\/p>\n\n\n\n
Olof R. Hjorth et al.; Expectancy effects on serotonin and dopamine transporters during SSRI treatment of social anxiety disorder: a randomized clinical trial<\/a>; Translational Psychiatry; https:\/\/doi.org\/10.1038\/s41398-021-01682-3<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Niv\u00e5erna av dopamin och placeboeffekten kan avg\u00f6ra om patienter med social \u00e5ngest f\u00f6rb\u00e4ttras eller inte vid medicinering med SSRI. En ny studie visar att hos patienter som hade en positiv […]<\/p>\n","protected":false},"author":6,"featured_media":8922,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4],"tags":[],"acf":[],"yoast_head":"\n
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