U radu se prikazuje klasifikacija antidepresiva,
koja uglavnom slijedi povijesni razvoj: od klasičnih (tricikličkih
i tetracikličkih) neselektivnih antidepresiva i inhibitora monoaminooksidaze
(IMAO) preko selektivnih inhibitora ponovne
pohrane serotonina (SIPPS) do antidepresiva s dualnim djelovanjem.
Teorije neuroplastičnosti u tekstu su samo spomenute,
jer još nemaju širu praktičnu primjenu u farmakoterapiji.
Tekst je pisan za hrvatskog liječnika praktičara, pa su u
detaljnijem opisu antidepresiva zastupljeni uglavnom lijekovi
registrirani u Hrvatskoj. To ne znači da autori smatraju da su
u nas neregistrirani antidepresivi slabije vrijednosti i
podnošljivosti i da neke od njih ne bismo željeli imati na
raspolaganju i za naše bolesnike.
Rad je pisan i kao udžbeničko štivo u savladavanju znanja iz
farmakoterapije depresivnih bolesnika.
Ističe se potreba individualnog i racionalnog pristupa i po-
štivanje sljedećih načela: liječenje depresivnog bolesnika s
blagom i umjerenom depresijom provodi se u domeni liječnika
primarnog kontakta, a s teškom depresijom i suicidalnošću u
domeni psihijatra. Terapijski rezistentne bolesnike treba
uputiti supspecijalistima iz tog područja.
U liječenju depresije primarno se primjenjuju antidepresivi. Uz
primjenu antidepresiva Često je vrlo važno dodati sedativ/hipnotik,
jer antidepresivi počinju djelovati nakon određenog vremena,
a depresivni bolesnik pati pa radi smanjenja njegove
patnje, ali i suradljivosti (compliance) treba izbjeći svaku
neprospavanu noć.This article shows the classification of antidepressants
that is mainly based on their historical development:
from classical (tricylic and tetracyclic) non-selective antidepressants
and monoamine oxidase inhibitors (MAOIs) to
selective serotonin reuptake inhibitors (SSRIs) and antidepressants
with dual action. The theories of neuroplasticity
have been only mentioned since they are not widely used in
pharmacotherapy.
As this text is intended for Croatian physicians, a detailed
description of antidepressants mainly includes the drugs registered
in Croatia. Of course, this neither reflects the authors’
opinion about the efficacy or tolerability of unregistered antidepressants
nor does it mean that they would not like to have
some of these drugs available for their patients.
As far as its practical implementation is concerned, this article
can also serve as a manual of pharmacotherapy for depressed
patients.
The need for individual and rational approach and the following
principles should be considered: the treatment of patients with
mild to moderate depression falls within the responsibility of
general practitioners, while the treatment of patients with serious
depression and suicidality falls within the responsibility of
psychiatrists. Therapeutically resistant patients should be
referred to relevant subspecialists.
The treatment of depression is primarily carried out with antidepressants.
In addition to antidepressants, it is often important
to coadminister sedatives/hypnotics because some time
is needed for antidepressants to start acting in order to avoid
sleepless nights and thus alleviate suffering and increase
patient compliance
