Tedaviye dirençli tek uçlu depresyonda ilaç seçimini etkileyen etmenler

Abstract

Tedaviye Dirençli Depresyon (TDD), insanların yaşam kalitesini azaltan yaygın ve malüliyete neden olan bir hastalıktır. Major depresyonlu hastaların üçte ikisi ilk antidepresan tedavisine cevap vermezler. Ancak TDD için uzlaşma sağlanmış bir tanım ve değerlendirme yöntemi henüz geliştirilmemiştir. TDD olarak değerlendirilen hastaların çoğu yanlış tanı veya yetersiz tedavi almışlardır. TDD hastaların ilk değerlendirilmesinde psikiyatrik tanıları ve tıbbi durumu ayrıntılı ele alınmalıdır. TDD tedavisinin düzenlenmesinde üç farmakolojik strateji vardır: antidepresan dozunu optimize etmek; güçlendirme/kombinasyon tedavisi ve ilaç değişikliğidir.

Keywords

• tedaviye direnç, depresyon, güçlendirme, ilaç kombinasyonu

Factors effecting drug selection for treatment resistant unipolar depression

Abstract

Treatment Resistant Depression (TRD) is a common and debilitating disease affecting much of people during their lifetime and leads to significant reductions in quality of life. Up to two thirds of patients with major depression will not respond to the first antidepressant medication. However, a clear consensus regarding the criteria defining and assessing method of TRD is not developed yet in the psychiatric community. Many patients who are considered treatment resistant are actually misdiagnosed or inadequately treated. Diagnostic reassessment is the first step during evaluation of patients with treatment-resistant depression and must include examining psychiatric and organic causes of depression. In managing TRD, three pharmacotherapy strategies are in clinical use: optimization of antidepressant dose, augmentation/combination therapies and switching pharmacotherapy.

Keywords

• treatment resistance, depression, augmentation, drug combination

References

1. : Berlim MT, Turecki G. Definition, assessment, and staging of treatment resistant refractory major depression: a review of current concepts and methods. Can J Psychiatry. 2007;52:46-54.
2. Keitner GI, Mansfield AK. Management of treatment-resistant depression. Psychiatr Clin North Am. 2012;35:249-65.
3. Souery D, Serretti A, Calati R, Oswald P, Massat I, Konstantinidis A, Linotte S, Bollen J, Demyttenaere K, Kasper S, Lecrubier Y, Montgomery S, Zohar J, Mendlewicz J. Switching antidepressant class does not improve response or remission in treatment-resistant depression. J Clin Psychopharmacol. 2011;31:512-6.
4. Nierenberg AA, Fava M, Trivedi MH, Wisniewski SR, Thase ME, McGrath PJ, Alpert JE, Warden D, Luther JF, Niederehe G, Lebowitz B, ShoresWilson K, Rush AJ. A comparison of lithium and T(3) augmentation following two failed medication treatments for depression: a STAR*D report. Am J Psychiatry. 2006;163:1519-30.
5. Connolly KR, Thase ME. If at first you don’t succeed: a review of the evidence for antidepressant augmentation, combination and switching strategies. Drugs. 2011; 71:43-64.
6. Nelson JC, Papakostas GI. Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials. Am J Psychiatry. 2009;166:980-91.