Consortium Psychiatricum
2024. Том 5. № 4. С. 40–62
doi:10.17816/CP15560
ISSN: 2712-7672 / 2713-2919 (online)
Применение мелатонинергических антидепрессантов для стабилизации ремиссии при депрессии, коморбидной с алкоголизмом, тревожными расстройствами и нейропсихиатрическими заболеваниями: систематический обзор
Аннотация
ВВЕДЕНИЕ: Депрессия является одним из самых распространенных психических заболеваний, при котором существенно увеличивается риск развития сопутствующих психиатрических и соматических расстройств. Хронобиологическая теория патогенеза депрессии объясняет взаимосвязь депрессивных симптомов с нарушениями регуляции циркадного ритма. Изменения циркадного ритма также наблюдаются при других заболеваниях: синдроме зависимости от алкоголя, тревожных расстройствах, эпилепсии и болезни Паркинсона. В связи с этим, растет интерес использования препаратов с мелатонинергическим механизмом действия в терапии депрессии, коморбидной с вышеперечисленными расстройствами.
ЦЕЛЬ: Целью данной работы является систематический обзор исследований, рассматривающих применение мелатонинэргических антидепрессантов (агомелатина и флувоксамина) для лечения депрессии, коморбидной с алкогольной зависимостью, тревожными расстройствами (тревожно-фобическое, паническое, генерализованное тревожное расстройство), или нейропсихиатрическими заболеваниями (эпилепсия, болезнь Паркинсона).
МЕТОДЫ: Для проведения систематического обзора отбирались экспериментальные исследования, систематические обзоры или мета-анализы, опубликованные на английском и русском языках, и описывающие применение флувоксамина и агомелатина в группах взрослых испытуемых, имеющих коморбидный диагноз рекуррентного депрессивного расстройства (согласно МКБ-10) или большого депрессивного расстройства (согласно DSM-5) с алкогольной зависимостью, тревожными расстройствами или нейропсихиатрическими заболеваниями. Поиск осуществлялся в научных базах PubMed, Cochrane Library и eLIBRARY. Качество отобранных исследований оценивалось с помощью Кокрейновского инструмента по оценке рисков систеатмическиих ошибок (Cochrane Risk of Bias tools). Результаты были представлены в виде нарративного синтеза и сгруппированы в соответствии с изучаемыми коморбидными состояниями.
РЕЗУЛЬТАТЫ: Всего было рассмотрено 20 статей (общая численность участников n=1833 человек). Результаты предполагают, что мелатонинергические антидепрессанты могут способствовать уменьшению депрессивной и тревожной симптоматики, улучшению сна, а также снижению влечения к употреблению алкоголя и выраженности двигательных симптомов болезни Паркинсона. Кроме того, использование фармакогенетического тестирования для выбора препарата и дозировки может повышать его терапевтическую эффективность.
ЗАКЛЮЧЕНИЕ: Результаты обзора выявляют выраженный недостаток клинических данных и руководств по применению препаратов с мелатонинергическим механизмом действия при депрессии, сочетанной с другими состояниями. В связи с этим на данный момент затруднительно сделать однозначный вывод об эффективности и безопасности применения агомелатина и флувоксамина при данных коморбидных нозологиях. Существующие исследования свидетельствуют об улучшении проявлений сочетанной симптоматики рассмотренных заболеваний. Дальнейшие направления исследований могут включать разработку и проведение двойных слепых рандомизированных клинических исследований по изучению применения мелатонинергических препаратов при депрессии, коморбидной с другими заболеваниями.
Общая информация
Ключевые слова: мелатонинергические антидепрессанты, депрессия, тревожные расстройства, алкоголизм, эпилепсия, болезнь Паркинсона
Рубрика издания: Обзоры
Тип материала: научная статья
DOI: https://doi.org/10.17816/CP15560
Финансирование. The research was performed within the framework of the state assignment of V.M. Bekhterev National Research Medical Centre for Psychiatry and Neurology 2024–2026 (XSOZ-2024-0014).
Получена: 28.07.2024
Принята в печать:
Для цитаты: Климанова С.Г., Радионов Д.С., Шова Н.И., Коцюбинская Ю.В., Ярыгина Ю.В., Березина А.А., Сивакова Н.А., Старунская Д.А., Якунина О.Н., Андрианова А.Е., Захаров Д.В., Рыбакова К.В., Караваева Т.А., Васильева А.В., Михайлов В.А., Крупицкий Е.М. Применение мелатонинергических антидепрессантов для стабилизации ремиссии при депрессии, коморбидной с алкоголизмом, тревожными расстройствами и нейропсихиатрическими заболеваниями: систематический обзор // Consortium Psychiatricum. 2024. Том 5. № 4. С. 40–62. DOI: 10.17816/CP15560
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