Current trends in formulation and application of pharmaceutical preparations in therapy of depression in children and adults

Abstract

Depression is the most common mental disorder in the general population and often requires long-term administration of antidepressants. Development of the modified release antidepressant products has led to the lower incidence of the adverse effects and improvement in the adherence, and subsequently to better therapeutic outcomes. Modified release may involve delayed and/or prolonged release of antidepressants. There is an increasing number of marketed antidepressant products in the form of orally dispersible tablets, for the treatment of a particular group of patients with impaired swallowing. Pharmacotherapy of depression in children represents a great challenge due to insufficient data regarding efficacy and safety. Furthermore, in the market of Republic of Serbia, there are no antidepressant products in the age-appropriate dosage forms for pediatric patients. It is, therefore, of great importance to address the risks related to the application of the conventional dosage forms of marketed antidepressants (tablets, hard capsules) to children. Novel treatment options include development of carriers for targeted delivery of antidepressants in the central nervous system. Intranasal administration of antidepressants is particularly favored since it allows the delivery of active ingredients via olfactory and trigeminal nerves. Other transmucosal routes of administration, such as buccal or sublingual, can provide improved therapeutic outcomes, compared to the conventional oral administration, due to circumvention of the intense metabolism of the active ingredients and undesired gastrointestinal side effects.

Depresija je najčešći mentalni poremećaj u opštoj populaciji i neretko zahteva dugotrajnu primenu lekova iz grupe antidepresiva. Razvojem preparata sa modifikovanim oslobađanjem lekovite supstance omogućeno je smanjenje neželjenih efekata i poboljšanje adherence, a samim tim i poboljšanje terapijskih ishoda. Modifikacija oslobađanja podrazumeva odloženo i/ili produženo oslobađanje antidepresiva. Za terapiju određene grupe pacijenata sa otežanim gutanjem od velikog značaja je i sve veći broj registrovanih preparata u obliku oralno-disperzibilnih tableta. Farmakoterapija depresije kod dece predstavlja veliki izazov zbog nedostatka podataka o efikasnosti i bezbednosti. Takođe, na tržištu Republike Srbije nisu registrovani preparati sa antidepresivima u farmaceutskim oblicima prilagođenim pedijatrijskom uzrastu. Zbog toga je veoma značajno razmotriti rizike povezane sa primenom konvencionalnih farmaceutskih oblika antidepresiva (tablete, tvrde kapsule) kod dece. Savremeni farmaceutski oblici podrazumevaju razvoj nosača za ciljanu isporuku antidepresiva u centralni nervni sistem. Naročito se ističe intranazalni put primene jer omogućava isporuku lekovitih supstanci putem olfaktornog i trigeminalnog nerva. I drugi transmukozni putevi primene, poput bukalnog ili sublingvalnog, omogućavaju unapređenje terapijskih ishoda jer se, u odnosu na peroralni put primene, zaobilazi intenzivan metabolizam lekovitih supstanci i izbegavaju neželjeni gastrointestinalni efekti.