Psychodynamiczne i farmakodynamiczne działanie leków

Volker Schulz

Summary
The therapeutic utiiity of medicines is nowadays usually measured in terms of parameters devised m the artificial surroundings of a double blind clinical trial. The difference between the actwe drug and the placebo is accepted as being the same as the desired overall effect. Yet, when applied to whole categories of medicines, this yardstick can be misleading, as has become apparent from the discussion which has recently arisen regarding the genuine and the illusory pharmacodynamic effects ofsynthetic antidepressants. Selectwe analysis of a representatwe number of placebo-controlled studies has shown that used for depressiue conditions, the psychodynamic components contribute far morę to the overall effect than do the pharmacodynamic components. In this respect, modern synthetic antidepressants arę no better than Hypericum products o f plant origin. Among other things, this means that for depressiue stałeś and similar indications, the safety, tolerability and acceptability of a medicine must be given much greater weight than its pharmacodynamic effect as assessed simply by testing against a placebo. The quantification of the two therapeutic components, as can be done by a placebo-controlled drug trial, has reuealed that the overall outcome of phytotherapy for uarious important indications o f this kind is predominantly attributable to the psychodynamic component. It may reasonably be assumed that the contribution madę by the pharmacodynamic effects to the overall therapeutic response will amount oniy to about 20-50%. This raises ąuestions regarding the clinical relevance and economic value of placebo-controlled studies. When assessing data on drug efficacy for the purpose of licensing applications, greater regard should be given to this reality.

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