Opis leczenia profilaktycznego u pacjentów z ChAD przekracza ramy obecnego opracowania. Warto tu wspomnieć o kontrowersjach dotyczących długotrwałego stosowania leków przeciwdepresyjnych w ChAD. Mimo zaleceń unikania ich stosowania w praktyce klinicznej często spotyka się ich nawet długotrwałe podawanie. W najnowszej metaanalizie, w której minimalny czas stosowania leków przeciwdepresyjnych wynosił cztery miesiące, wykazano, że leki przeciwdepresyjne w porównaniu z normotymicznymi wiążą się z większym ryzykiem wystąpienia hipomanii/manii. Nie odnotowano między tymi grupami leków różnic w zapobieganiu depresji. Obserwowano niewielką przewagę połączenia leków przeciwdepresyjnych z normotymicznymi nad samymi normotymicznymi w zapobieganiu nawrotom depresji. Większe korzyści i mniejsze ryzyko stosowania leków przeciwdepresyjnych obserwuje się u pacjentów z ChAD typu 2.

Podsumowanie

  • Nadal nie ma jednoznacznych wytycznych w zakresie zapobiegania nawrotom depresji.
  • Populacja pacjentów z depresją jest zróżnicowana. W ustaleniu leczenia utrwalającego poprawę i profilaktycznego trzeba wziąć pod uwagę czynniki ryzyka nawrotu występujące u danego chorego.
  • Nie można zapominać o współchorobowości w postaci zaburzeń lękowych, zaburzeń osobowości lub też o konieczności diagnostyki w kierunku ChAD.
  • Istnieje obecnie wiele możliwości zapobiegania nawrotom, a ich łączne, zindywidualizowane zastosowanie z pewnością korzystnie wpłynie na przebieg choroby i funkcjonowanie danego pacjenta.

ABSTRACT

Prevention of new affective episodes is an essential goal of maintenance therapy following a first-in-life episode of depression. Risk factors for recurrence in a particular patient have to be taken into account. They include prior course of the disease, presence of certain comorbidities and response to previous treatment. Moreover, conversion to bipolar disorder is a very important issue. It is difficult to give clear-cut recommendations concerning continuation/maintenance treatment in depression. Personalized approaches with individualized application of available therapeutic options are necessary.

KEYWORDS: depression, relapse, recurrence, prevention, treatment, bipolar.

Zdjęcie: archiwum prywatne

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