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Antidepressants: Myths, facts and perspectives

Antidepresivi - mitovi, činjenice i perspektive

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2017
2974.pdf (219.8Kb)
Authors
Obradović, Aleksandar
Savić, Miroslav
Article (Published version)
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Abstract
Antidepressants are one of the most widely used and criticized drug classes. Long-term effects leading to clinical efficacy of antidepressants in indications such as depression or anxiety disorders are poorly understood. The analysis of clinical trials suggests that, to a substantial degree, listening to antidepressants means hearing placebo. The precipitation of suicidal ideation is a possibility that needs to be considered when introducing antidepressants, especially in young patients. The discontinuation symptoms following cessation of treatment emerge frequently, and essentially are manifestations of withdrawal. Many, if not most, patients require multiple modifications in treatment in order to reach remission and avoid relapse or recurrence. However, these drugs are needed in clinical practice, and it is of paramount importance to precisely tailor treatment with antidepressants and adjunctive drugs to achieve optimal efficacy with minimal adverse effects. There are also hopes that... novel drugs with rapid ketamine-like antidepressant actions may be introduced in the near future, thus solving the issue of acute management of severe depressions.

Antidepresivi spadaju u lekove koji su u isto vreme najviše korišćeni i kritikovani. Dugotrajni efekti antidepresiva koji obezbeđuju kliničku efikasnost u indikacijama kao što su depresija ili anksiozni poremećaji slabo su razjašnjeni. Analiza rezultata kliničkih ispitivanja sugeriše da antidepresivnom dejstvu ovih lekova, u znatnom obimu, doprinosi placebo efekat. Precipitacija misli o suicidu predstavlja mogućnost koja se mora temeljno razmotriti prilikom uvođenja antidepresiva, posebno kod mladih pacijenata. Simptomi diskontinuacije nakon prekida terapije javljaju se često, i suštinski predstavljaju manifestacije obustave. Višestruke modifikacije tretmana, a u cilju postizanja remisije i izbegavanja relapsa ili recidiva, zahtevaju brojni pacijenti, ako ne i većina njih. Uprkos svemu, ovi lekovi jesu neophodni u kliničkoj praksi, i precizno prilagođavanje tretmana antidepresivima i adjuvantnim lekovima od neprocenjivog je značaja u cilju postizanja optimalne efikasnosti sa minimumom ...neželjenih efekata. Dodatno, postoje očekivanja da bi novi lekovi sa brzim antidepresivnim dejstvom sličnim ketaminu mogli da budu uvedeni u skorijoj budućnosti, čime bi se prevazišao problem akutnog zbrinjavanja teških depresija.

Keywords:
mechanism of action / placebo effect / suicidality / discontinuation / mehanizam dejstva / placebo efekat / suicidalnost / diskontinuacija
Source:
Arhiv za farmaciju, 2017, 67, 5, 291-301
Publisher:
  • Savez farmaceutskih udruženja Srbije, Beograd

DOI: 10.5937/arhfarm1705291O

ISSN: 0004-1963

Scopus: 2-s2.0-85067565559
[ Google Scholar ]
URI
https://farfar.pharmacy.bg.ac.rs/handle/123456789/2976
Collections
  • Radovi istraživača / Researchers’ publications
Institution/Community
Pharmacy
TY  - JOUR
AU  - Obradović, Aleksandar
AU  - Savić, Miroslav
PY  - 2017
UR  - https://farfar.pharmacy.bg.ac.rs/handle/123456789/2976
AB  - Antidepressants are one of the most widely used and criticized drug classes. Long-term effects leading to clinical efficacy of antidepressants in indications such as depression or anxiety disorders are poorly understood. The analysis of clinical trials suggests that, to a substantial degree, listening to antidepressants means hearing placebo. The precipitation of suicidal ideation is a possibility that needs to be considered when introducing antidepressants, especially in young patients. The discontinuation symptoms following cessation of treatment emerge frequently, and essentially are manifestations of withdrawal. Many, if not most, patients require multiple modifications in treatment in order to reach remission and avoid relapse or recurrence. However, these drugs are needed in clinical practice, and it is of paramount importance to precisely tailor treatment with antidepressants and adjunctive drugs to achieve optimal efficacy with minimal adverse effects. There are also hopes that novel drugs with rapid ketamine-like antidepressant actions may be introduced in the near future, thus solving the issue of acute management of severe depressions.
AB  - Antidepresivi spadaju u lekove koji su u isto vreme najviše korišćeni i kritikovani. Dugotrajni efekti antidepresiva koji obezbeđuju kliničku efikasnost u indikacijama kao što su depresija ili anksiozni poremećaji slabo su razjašnjeni. Analiza rezultata kliničkih ispitivanja sugeriše da antidepresivnom dejstvu ovih lekova, u znatnom obimu, doprinosi placebo efekat. Precipitacija misli o suicidu predstavlja mogućnost koja se mora temeljno razmotriti prilikom uvođenja antidepresiva, posebno kod mladih pacijenata. Simptomi diskontinuacije nakon prekida terapije javljaju se često, i suštinski predstavljaju manifestacije obustave. Višestruke modifikacije tretmana, a u cilju postizanja remisije i izbegavanja relapsa ili recidiva, zahtevaju brojni pacijenti, ako ne i većina njih. Uprkos svemu, ovi lekovi jesu neophodni u kliničkoj praksi, i precizno prilagođavanje tretmana antidepresivima i adjuvantnim lekovima od neprocenjivog je značaja u cilju postizanja optimalne efikasnosti sa minimumom neželjenih efekata. Dodatno, postoje očekivanja da bi novi lekovi sa brzim antidepresivnim dejstvom sličnim ketaminu mogli da budu uvedeni u skorijoj budućnosti, čime bi se prevazišao problem akutnog zbrinjavanja teških depresija.
PB  - Savez farmaceutskih udruženja Srbije, Beograd
T2  - Arhiv za farmaciju
T1  - Antidepressants: Myths, facts and perspectives
T1  - Antidepresivi - mitovi, činjenice i perspektive
VL  - 67
IS  - 5
SP  - 291
EP  - 301
DO  - 10.5937/arhfarm1705291O
UR  - conv_583
ER  - 
@article{
author = "Obradović, Aleksandar and Savić, Miroslav",
year = "2017",
abstract = "Antidepressants are one of the most widely used and criticized drug classes. Long-term effects leading to clinical efficacy of antidepressants in indications such as depression or anxiety disorders are poorly understood. The analysis of clinical trials suggests that, to a substantial degree, listening to antidepressants means hearing placebo. The precipitation of suicidal ideation is a possibility that needs to be considered when introducing antidepressants, especially in young patients. The discontinuation symptoms following cessation of treatment emerge frequently, and essentially are manifestations of withdrawal. Many, if not most, patients require multiple modifications in treatment in order to reach remission and avoid relapse or recurrence. However, these drugs are needed in clinical practice, and it is of paramount importance to precisely tailor treatment with antidepressants and adjunctive drugs to achieve optimal efficacy with minimal adverse effects. There are also hopes that novel drugs with rapid ketamine-like antidepressant actions may be introduced in the near future, thus solving the issue of acute management of severe depressions., Antidepresivi spadaju u lekove koji su u isto vreme najviše korišćeni i kritikovani. Dugotrajni efekti antidepresiva koji obezbeđuju kliničku efikasnost u indikacijama kao što su depresija ili anksiozni poremećaji slabo su razjašnjeni. Analiza rezultata kliničkih ispitivanja sugeriše da antidepresivnom dejstvu ovih lekova, u znatnom obimu, doprinosi placebo efekat. Precipitacija misli o suicidu predstavlja mogućnost koja se mora temeljno razmotriti prilikom uvođenja antidepresiva, posebno kod mladih pacijenata. Simptomi diskontinuacije nakon prekida terapije javljaju se često, i suštinski predstavljaju manifestacije obustave. Višestruke modifikacije tretmana, a u cilju postizanja remisije i izbegavanja relapsa ili recidiva, zahtevaju brojni pacijenti, ako ne i većina njih. Uprkos svemu, ovi lekovi jesu neophodni u kliničkoj praksi, i precizno prilagođavanje tretmana antidepresivima i adjuvantnim lekovima od neprocenjivog je značaja u cilju postizanja optimalne efikasnosti sa minimumom neželjenih efekata. Dodatno, postoje očekivanja da bi novi lekovi sa brzim antidepresivnim dejstvom sličnim ketaminu mogli da budu uvedeni u skorijoj budućnosti, čime bi se prevazišao problem akutnog zbrinjavanja teških depresija.",
publisher = "Savez farmaceutskih udruženja Srbije, Beograd",
journal = "Arhiv za farmaciju",
title = "Antidepressants: Myths, facts and perspectives, Antidepresivi - mitovi, činjenice i perspektive",
volume = "67",
number = "5",
pages = "291-301",
doi = "10.5937/arhfarm1705291O",
url = "conv_583"
}
Obradović, A.,& Savić, M.. (2017). Antidepressants: Myths, facts and perspectives. in Arhiv za farmaciju
Savez farmaceutskih udruženja Srbije, Beograd., 67(5), 291-301.
https://doi.org/10.5937/arhfarm1705291O
conv_583
Obradović A, Savić M. Antidepressants: Myths, facts and perspectives. in Arhiv za farmaciju. 2017;67(5):291-301.
doi:10.5937/arhfarm1705291O
conv_583 .
Obradović, Aleksandar, Savić, Miroslav, "Antidepressants: Myths, facts and perspectives" in Arhiv za farmaciju, 67, no. 5 (2017):291-301,
https://doi.org/10.5937/arhfarm1705291O .,
conv_583 .

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