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Алгоритм назначения антидепрессантов в реальной клинической практике
Путилина М.В. Алгоритм назначения антидепрессантов в реальной клинической практике. Consilium Medicum. 2018; 20 (9): 101–107. DOI: 10.26442/2075-1753_2018.9.101-107
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Putilina M.V. Algorithm of antidepressants use in clinical practice. Consilium Medicum. 2018; 20 (9): 101–107. DOI: 10.26442/2075-1753_2018.9.101-107
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Аннотация
По данным Всемирной организации здравоохранения, тревожно-депрессивные расстройства (ТДР) и инсульт входят в десятку самых значимых проблем здравоохранения. Симптомы тревоги или субсиндромальные ТДР регистрируются у 76% населения планеты. Депрессия, с которой сталкиваются врачи-интернисты в повседневной практике, чаще всего протекает в скрытой, атипичной форме, маскируясь разнообразными психовегетативными, алгическими, соматическими проявлениями. Болевой синдром всегда сочетается с жалобами психопатологического и психовегетативного характера. Базовыми препаратами терапии являются антидепрессанты. Препараты показаны не только когда вегетативные расстройства являются проявлением депрессии, но и когда они протекают в рамках тревожных и тревожно-фобических расстройств, даже если очевидной депрессии не выявляется.
Ключевые слова: депрессия, генерализованное тревожное расстройство, нейропатическая боль, антидепрессанты, эффективность, безопасность.
Ключевые слова: депрессия, генерализованное тревожное расстройство, нейропатическая боль, антидепрессанты, эффективность, безопасность.
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According to the World Health Organization data mixed anxiety and depressive disorder (MADD) and stroke are one of the ten most important healthcare problems. Anxiety symptoms and subsyndromal MADD are found in 76% of the world's population. Depression that internal medicine specialists come across in everyday practice mostly exists in an atypical latent form and is masked with various psychovegetative, algesic and somatic manifestations. Pain syndrome is always combined with various psychopathologic and psychovegetative complaints. The basis therapy includes antidepressant medications that are indicated not only when autonomic disturbances are symptoms of depression but also when they are a part of anxiety and anxiety-phobic disorders even if there is no evident depression.
Key words: depression, generalized anxiety disorder, neuropathic pain, antidepressants, effectiveness, safety.
Полный текст
Список литературы
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2. Egede LE. Major depression in individuals with chronic medical disorder: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. General Hospital Psychiatry 2007; 29: 409–16.
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14. Taylor WD, Aizenstein HJ, Alexopoulos GS. The vascular depression hypothesis: mechanisms linking vascular disease with depression. Mol Psychiatry 2013; 18 (9): 963–74. DOI: 10.1038/mp.2013.20
15. Breslau N, Lipton RB, Stewart WF. Comorbidity of pain and depression: investigation potential etiology and prognosis. Neurology 2003; 60: 1308–12.
16. Bruti G, Magnotti MC, Iannetti G. Migraine and depression: bidirectional co-morbidities? Neurol Sci 2012; 33 (Suppl. 1): 107. https://doi.org/10.1007/s10072-012-1053-6
17. Rudy TE, Kerns RD, Turk DC. Chronic pain and depression: towards a cognitive behavioral medication model. Pain 2012, 35: 129–40. DOI: 10.1016/0304-3959(88)90220-5
18. Krupatkin A.I., Kuleshov A.A., Sokolova T.V., Gospod A.O. Patopsihologicheskie aspekty bolevyh sindromov v nizhnej chasti spiny. Zhurn. nevrologii i psihiatrii im. S.S.Korsakova. 2017; 117 (4): 102–6. DOI: 10.17116/jnevro201711741102-106 [in Russian]
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32. Cipriani A et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 2009; 373 (9665): 746–58.
33. Eiji Kirino. Escitalopram for the management of major depressive disorder: a review of its efficacy, safety, and patient acceptability. Patient Prefer Adherence 2012; 6: 853–61.
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36. Montgomery SA, Lader M, Burger V et al. Escitalopram and paroxetine in fixed doses for the treatment of social anxiety disorder (SAD). Nord J Psychiat 2003; 57: 103.
37. Montgomery SA, Huusom AKT, Bothmer J. A randomised study comparing escitalopram with venlafaxine XR in primary care patients with major depressive disorder. Neuropsychobiology 2004; 50: 57–64.
38. Crocco EA, Jaramillo S, Cruz-Ortiz C. Pharmacological Management of Anxiety Disorders in the Elderly. Curr Treat Options Psych 2017; 4: 33. https://doi.org/10.1007/s40501-017-0102-4
39. Bird ST, Crentsil V, Temple R et al. Cardiac safety concerns remain for citalopram at dosages above 40 mg/day. Am J Psychiatr 2014; 171: 17– 9. https://doi.org/10.1176/appi.ajp.2013.13070905
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47. Able SL, Cui Z, Shen W. Duloxetine treatment adherence across mental health andchronic pain conditions. Clinicoecon Outcomes Res 2014; 6: 75–81. DOI: 10.2147/CEOR.S52950. eCollection 2014
48. Hughes LM, Wiffen RA. Philip Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. J Cochrane Database Syst Rev 2014; 1: 2.
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50. Radovanovič M, Pišljar M, Barbič-Žagar B et al. Efficacy and Safety of Duloxetine in the Treatment of Depression, Generalized Anxiety Disorder and Diabetic Peripheral Neuropathic Pain. Viceversa 2017; 63: 60–72.
Авторы
М.В.Путилина
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
profput@mail.ru
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
profput@mail.ru
________________________________________________
M.V.Putilina
N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
profput@mail.ru
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