Neurometabolic strategy of pharmacotherapy of affective disorders: whom, when and why?
- State Institution «D.F. Chebotarev’s Institute of Gerontology of the NAMS of Ukraine», Kyiv, Ukraine
Summary. One of the most important from a clinical point of view problems related to the diagnosis and treatment of depression, especially in general medical and neurological practice, is a significant increase in affective disorders, called dysthymia, i.e. psychoemotional states characterized by mood swings or predominance of reduction of psycho-emotional state, a feeling of depression, indifference, which however is not stable and is periodically replaced by «normal» perception of themselves and others. Such conditions, not being depression in the strictly nosological sense of the term, may precede the development of depressive disorder, and may be characterized by stability for a long time. In dysthymia, the appointment of «classic» antidepressants is not always indicated. In this situation, the so-called thymo-stabilisers, or mood correctors, may be more useful — drugs with a mild complex mechanism of action on the psycho-emotional sphere, which increase mood and vitality without a pronounced effect on psychopathological symptoms. An innovative domestic complex Deprilium®, which includes S-adenosyl-L-methionine, L-methylfolate and methylcobalamin, is fundamentally different from conventional antidepressants and characterizes another strategy of action — neurometabolic.
УДК 159.942.5+616.8-008.64:615.214.2
DOI: 10.32471/umj.1680-3051.141.198273
References:
- Kupko N. (2019) Screening and diagnosis of depression in primary care. НейроNews, 9(110): 24–28 (In Ukr.).
- Ferrari A.J., Charbos K.J., Norman R.E. et al. (2013) The epidemiological modeling of major depressive disorder: application to the Global Burden of Disease Study 2010. PLoS One (https://doi.org/10.1371/journal.pone.0069637).
- Maruta N.A. (2001) Modern depressive disorders (clinical and psychopathological features, diagnosis, therapy). Ukr. Bull. Psychoneurol., 9(4): 79–82. (In Rus.).
- Montgomery S.A. (2006) Why do we need vew and better antidepressants ? Int. Clin. Psychopharmacol., 21(Suppl. 1): S1–S10.
- Bosker F.J., Westerink B.H., Cremers T.I. et al. (2004) Future antidepressants: what is in the pipeline and what is missing? CNS Drugs, 18: 705–732.
- Fuchs E., Simon M., Schmelting B. (2006) Pharmacology of a new antidepressant: benefit of the implication of the melatonergic system. Int. Clin. Psychopharmacol., 21(Suppl. 1): S17–S20.
- Schatzberg A., DeBattista C. (2015) Manual of Clinical Psychopharmacology (Eight Ed.). Amer. Psychiat. Publ., Washington, 687 p.
- De Berardis D., Orsolini A., Serroni N. et al. (2016) A comprehensive review on the efficacy of S-adenosyl-methionine in major depressive disorder. CNS & Neurol. Disord. Drug Target, 15: 1–10.
- Spillmann M., Fava M. (1996) S-adenosyl-methionine (ademethionine) in psychiatric disorders. CNS Drugs, 6: 416–425.
- Papakostas G.L., Mishoulon D., Shyu I. et al. (2010) S-adenosyl-methionine (SAMe) augmentation of serotonin reuptake inhibitors for antidepressants nonresponders with major depressive disorder: a double-blind, randomized clinical trial. Am. J. Psychiat., 167: 942–948.
- Alpert J.E., Papakostas G., Mochoulon D. (2008) One-carbon metabolism and the treatment of depression: roles of S-adenosyl-methionine and folate. Natural Medications for Psychiatric Disorders. Considering the Alternatives, 2nd ed. Lippincott & Co, PA, 68–83 p.
- Bell K.M., Potkin S.G., Carreon D. et al. (1994) S-adenosyl-methionine blood levels in major depression: changes with drug treatment. Acta Neurol. Scand., Suppl., 154: 15–18.
- Mischoulon D., Fava M. (2002) Role of S-adenosyl-methionine in the treatment of depression: a review of the evidence. Am. J. Clin. Nutr., 76 (suppl.): 1158S–1161S.
- Papakostas G.L., Thase M.F., Fava M. et al. (2007) Are antidepressant drugs that combine serotonergic and noradrenergic mechanisms of action more effective than the selective serotonin reuptake inhibitors in treating major depressive disorder? A metaanalysis of studies of newer agents. Biol. Psychiat., 62: 1217–1227.
- Duman R.S. (2004) Theories of depression — from monoamines to neuroplasticity. Neuroplasticity: a new approach to the pathophysiology of depression. Sci. Press, London, 1–12 p.
- Papakostas G.I., Pancheri P., Scapicchio P., Chiare R.D. (2002) A double-blind, randomized, parallel-group efficacy and safety study of intramuscular S-adenosyl-methionine 1,4-butanedisuphonate (SAMe) versus in patients with major depressive disorder. Int. J. Neuropsychopharmacol., 5: 287–294.
- Alpert J.E., Papakostas G., Mischoulon D. et al. (2004) S-adenosyl-methionine (SAMe) as an adjunct for resistant major depressive disorder: an open trail following partial or nonresponse to selective serotonin reuptake inhibitors or venlafaxine. J. Clin. Psychopharmacol., 24: 661–664.
- Sarris J., Papakostas G.L., Vitolo O. et al. (2014) S-adenosyl-methionine (SAMe) versus escitalopram and placebo in major depression RCT: efficacy and effects of histamine and carnitine as moderators of response. J. Affect. Disord., 164: 76–81.
- Burchinsky S.G. (2018) Pharmacotherapy of post-stroke depression: the problem and criteria for choosing an antidepressant. НейроNews, 6: 37–41 (In Rus.).
- Parfenov V.A. (2012) Post-stroke depression: prevalence, pathogenesis, diagnosis and treatment. Nevrol. neuropsychiatrist. psychosomat., 4: 84–88 (In Rus.).
- Fava M., Borus J.S., Alpert J.E. et al. (1997) Folate, vitamin B12, and homocysteine in major depressive disorder. Am. J. Psychiat., 154: 426–428.
- Gilbody S., Lightfoot T., Sheldon T. (2007) Is low folate a risk factor for depression? A meta-analysis and exploration of heterogeneity. J. Epidemiol. Commun. Health, 61: 631–637.
- Papakostas G.I., Petersen T., Lebowitz B.D. et al. (2005) The relationship between serum folate, vitamin B12, and homocysteine levels in major depressive disorder and the timing of improvement with fluoxetine. Int. J. Neuropsychopharmacol., 8: 523–528.
- Papakostas G.L., Shelton R.C., Zajecka J.M. et al. (2012) L-methylfolate as adjunctive therapy for SSRI-resistant major depression: results of two randomized, double-blind, parallel-sequential trials. Am. J. Psychiat., 169: 1267–1274.
- Coppen A., Bollander-Gouaille C. (2005) Treatment of depression: time to consider folic acid and vitamin B12. J. Psychopharmacol., 19: 59–65.
- Sved E.U., Wasay M., Awan S. (2013) Vitamin B12 supplementation in treating major depression disorder: a randomized controlled trials. Open Neurol., 7: 44–48.
Leave a comment