Per l’articolo di queste mese ho deciso di collaborare con una professionista che stimo molto, la Dottoressa Roberta Trapani, medico specializzando in medicina generale.
Insieme alla Dottoressa ci siamo interrogate sulle problematiche legate all’abuso farmacologico e alla falsa aspettativa che questo possa essere la soluzione ad ogni tipo di problema. Come riporta uno studio del CUFRAD “In Italia dal 2000 ad oggi il consumo di farmaci è aumentato del 60%. Il 20% degli italiani assume farmaci senza passare dal medico, percentuale che sale al 40% nella fascia di età compresa tra i 25 e i 34 anni. Oltre agli effetti benefici ogni farmaco può però comportare effetti indesiderati” (www.alcolnews.it).
La dottoressa Trapani infatti riscontra tale problematica anche tra i suoi pazienti: “Un farmaco molto richiesto è l’antibiotico o l’antiinfiammatorio, che per alcuni pazienti costituisce un rimedio a qualsiasi tipo di disturbo. Noi in qualità di medici cerchiamo sempre di prevenire ed evitare gli abusi farmacologici. Qualora ci accorgessimo di un uso inappropriato di un farmaco da parte di un paziente cerchiamo di spiegargli perché è inutile o addirittura dannoso continuare ad usare quel farmaco in tal modo. Ad esempio, in caso di influenza è inopportuno ricorrere subito all’antibiotico senza avere consultato prima il proprio medico, il quale dopo una attenta visita deciderà se si tratta di una sola forma virale quindi senza la necessità di usare l’antibiotico o di altro”.
L’obiettivo del medico di famiglia è quello di identificare il problema, comprenderne la cause, fornire cure primarie al paziente e in alcuni casi indirizzarlo da uno specialista se il problema dovesse persistere nonostante la terapia.
Perché allora i pazienti continuano ad abusare in modo inadeguato dei farmaci? Di fronte alle attività “non gradite” le persone possono mettere in atto diversi meccanismi di difesa per avere la sensazione di autoproteggersi, anche se in realtà si autodanneggiano:
– MINIMIZZAZIONE: “Qualche giorno passerà, sarà solo stress”: si tende a ridurre l’entità del problema così da non sentirsi in dovere di preoccuparsi o fare ulteriori analisi, ad esempio.
– NEGAZIONE: “E’ sempre stato così”, o “sarà l’età”: eliminazione totale del problema, spesso associata alla NORMALIZZAZIONE, ovvero alla falsa spiegazione che sia normale quanto stia accadendo.
– EVITAMENTO: la frase tipica “è inutile che io vada da quel medico, tanto non capisce niente” permette anche di deresponsabilizzarsi dal peso di una visita non effettuata.
– PROCASTINAZIONE: “Lo farò quando avrò tempo”, ovvero il rimandare ad un momento non ben definito una certa attività.
In tutti questi casi alla base può essere presente una forte ansia anticipatoria che impedisce di affrontare una situazione per la quale si pensa di non avere le risorse adatte. L’ansia, da un punto di vista evoluzionistico, rappresenta un risposta adattiva nell’uomo, perché costituisce un campanello di allarme che porta il soggetto ad attivarsi fisicamente di fronte ad un possibile pericolo.
Il problema subentra quando la soglia di attivazione di tale ansia si abbassa notevolmente, tanto da attivare il soggetto anche di fronte a stimoli che non costituiscono un reale pericolo, limitandone così le attività e le scelte. In questo caso l’ansia dovrebbe essere presa in considerazione dal paziente perché mostra che “qualcosa nel nostro corpo non va bene”, quindi andrebbe esaminata a fondo nella sua dinamica di sviluppo, e non solo abbassata con un farmaco.
Il farmaco infatti costituisce solo una parte del possibile percorso di cura, fondamentale per riequilibrare i parametrici fisici del nostro corpo ma inutile nel comprendere quale sia la vera causa che si nasconde dietro un’ansia prolungata e invalidante. Mancando una parte fondamentale di tale trattamento, spesso il farmaco non basta per raggiungere l’aspettativa di guarigione che il paziente possiede, per cui, nella speranza di un miglioramento, continua la terapia farmacologica anche oltre il termine prescritto e si convince che “per ora va bene così”.
A tal proposito la Dottoressa Trapani riporta un caso specifico anche inerente all’ambito psicologico: “I farmaci più richiesti in ambito psichico sono gli ansiolitici (le benzodiazepine) in particolare quelli per dormire, richiesti da soggetti agitati che non riescono soprattutto ad addormentarsi. Alcuni di questi sono proprio soggetti ansiosi che all’idea di separarsi dal farmaco per dormire e vedere come si trovano… vanno ancora più in ansia”: il farmaco assume le sembianze della famosa copertina di Linus e passa da cura a limitazione.
In conclusione, di fronte a periodi di forte ansia generalizzata o legata allo stato di salute, è giusto seguire l’iter medico corretto che prevede un primo contatto con il medico di famiglia il quale, valutando adeguatamente la situazione, indirizzerà eventualmente il paziente da uno specialista che possa approfondire la situazione. Se il paziente si accorge di mettere in atto i meccanismi sopra descritti, è necessario che ne parli al medico o si rivolga ad un psicologo per affrontare la situazione al meglio, e non si riduca all’utilizzo delle benzodiazepine che costituiscono solo una copertura di benessere e non una soluzione al problema.
Autore: Dott.ssa Valentina Galuppo
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