| Abstract | Depresija je poremećaj raspoloženja od kojeg u svijetu boluje više od 280 milijuna ljudi te predstavlja veliki javnozdravstveni problem. Karakterizira je sniženo raspoloženje, smanjenje energije i umor te nedostatak volje i zadovoljstva. Pacijenti koji boluju od depresije imaju smanjeno društveno i radno svakodnevno funkcioniranje. Temelj liječenja depresije čine antidepresivi. Zbog dostupnosti širokog spektra farmakoloških i nefarmakoloških opcija, između 70 i 90% pacijenata postiže zadovoljavajući terapijski odgovor, dok preostali pacijenti ispunjavaju kriterije za terapijski rezistentnu depresiju (TRD). TRD predstavlja veliki izazov za čitavo društvo te nemogućnost postizanja remisije uzrokuje veliku disfunkcionalnost pacijenata i njihovih obitelji, kao i velike financijske izdatke u zdravstvenom sustavu. U Republici Hrvatskoj odobren je brzodjelujući antidepresiv esketamin u intranazalnom spreju za liječenje TRD-a. Esketamin je S-enantiomer ketamina i nekompetitivni antagonist N-metil-D-aspartatnog receptora (NMDA) te ima veći afinitet za receptore od ketamina. Osim za TRD, esketamin je odobren za liječenje velikog depresivnog poremećaja sa suicidalnim ideacijama i ponašanjem. U liječenju se može davati u kombinaciji sa selektivnim inhibitorima ponovnog unosa serotonina (engl. selective serotonin reuptake inhibitor, SSRI, SIPPS) ili selektivnim inhibitorima ponovnog unosa serotonina i noradrenalina (engl. serotonin-norepinephrine reuptake inhibitor, SNRI). Najčešće nuspojave su vrtoglavica, disocijacija, mučnina, somnolencija i povišenje krvnog tlaka. Duljina trajanja nuspojava je najčešće do 2 sata nakon primjene esketamina. Trenutno se istražuje i za liječenje anksioznosti, bipolarne depresije, graničnog poremećaja ličnosti, postpartalne depresije i drugih psihičkih poremećaja. Iako je dokazano da je esketamin efikasan i siguran lijek, nužno je nastaviti istraživati kako bi se potpuno razjasnio njegov mehanizam djelovanja te umanjila moguća terapijska rezistencija kod pacijenata. |
| Abstract (english) | Depression is a mood disorder from which more than 280 million people worldwide suffer and represents a major public health problem. It is characterized by lowered mood, reduced energy, and fatigue, as well as a lack of will and pleasure. Patients suffering from depression have reduced social and occupational daily functioning. The cornerstone of treatment are antidepressants. Given the availability of a wide range of pharmacological and non-pharmacological treatments, 70 to 90 % of patients achieve a satisfactory therapeutic response, while the remaining patients meet the criteria for treatment-resistant depression (TRD). TRD presents a major challenge for the entire society, and the inability to achieve remission causes significant dysfunction for patients, and their families, as well as large financial expenses in the healthcare system. In the Republic of Croatia, a fast-acting antidepressant, esketamine, in a nasal spray, has been approved for the treatment of TRD. Esketamine is the S-enantiomer of ketamine and a non-competitive antagonist of the N-methyl-D-aspartate receptor (NMDA) and has a higher affinity for the receptors than ketamine. Besides TRD, esketamine is approved for the treatment of major depressive disorder with suicidal ideation and behavior. In treatment, it can be given in combination with selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). The most common side effects are dizziness, dissociation, nausea, somnolence, and increased blood pressure. The duration of side effects is usually up to 2 hours after the administration of esketamine. It is currently being investigated for the treatment of anxiety, bipolar depression, borderline personality disorder, postpartum depression, and other psychiatric disorders. Although it has been proven that esketamine is an effective and safe drug, it is necessary to continue research to clarify its mechanism of action fully and to reduce possible therapeutic resistance in patients. |
