Antidepresivi i suicidalnost

Cilj istraživanja: Cilj ovog istraživanja je utvrditi utjecaj antidepresiva na suicidalnost kod depresivnih pacijenata, njihov protektivni učinak, ali i povećan rizik od suicida. Rad bi mogao doprinijeti u budućem kreiranju smjernica za liječenje depresije i pristupu prema pacijentima sklonim suicidalnim ideacijama. U konačnici, praćenjem sigurnosti antidepresiva i njihovog učinka s obzirom na težinu bolesti i dob, tim pacijentima bi se mogla povećati kvaliteta života i smanjiti broj recidiva. Ispitanici i metode: Prilikom izrade i oblikovanja ovog rada, pretraženi su objavljeni izvorni i pregledni znanstveni radovi. Osnovu rada činile su kliničke studije. Literatura je sustavno pregledana iz područja duševnih poremećaja povezanih sa suicidalnosti. Korišteni su sažetci opisa svojstava i djelovanja lijekova i baza lijekova za tražene terapijske skupine. Bibliografske baze podataka PubMed, Web of Science, Google Scholar, Cochrane pretražene su prema ključnim riječima: major depressive disorder, antidepressants, suicidality, suicidal behaviour, suicidal ideation, young adults, children, side effect, safety, efficacy. Zaključak: Analizom velike količine podataka dolazi se do zaključka da se suicidalne ideacije, događaji i sam čin samoubojstva u rijetkim slučajevima mogu potaknuti liječenjem antidepresivima, primarno inhibitorima ponovne pohrane serotonina. Kliničke karakteristike poput agitacije, ego-distoničnih misli i impulzivnosti možemo smatrati znakovima upozorenja, zbog čega je potrebno navedenim pacijentima posvetiti pozornost, osobito u prva 2 tjedna terapije antidepresivima. Podaci ukazuju na mogućnost prevencije neželjenih suicidalnih događaja kombiniranjem terapije antidepresiva s antipsihoticima na samom početku liječenja. Posebno se intrigantnim čini antisuicidalni učinak ketamina i esketamina u malim dozama. Sve se više dokaza navodi o ulozi opioidnog sustava u suicidalnom ponašanju. Neke studije sugeriraju da suicidalni pacijenti imaju disfunkciju opioidnog sustava, čime se otvaraju potencijalno nove terapijske mogućnosti.Aim of the study: The aim of this study was to determine the impact of antidepressants on suicidality in depressed patients, their protective effect, but also an increased risk of suicide. The paper could contribute to the future development of guidelines for the treatment of depression and the approach to patients prone to suicidal ideation. Ultimately, by monitoring the safety of antidepressants and their effect with respect to disease severity and age, these patients could be able to increase their quality of life and reduce their relapse. Respondents and methods: During the preparation and formation of this paper, published original and reviewed scientific papers were studied. The work was based on clinical studies. The literature has been systematically reviewed in the area of mental disorders associated with suicidality. Summaries of descriptions of drug properties and effects and drug databases for the required therapeutic groups were used. Bibliographic databases PubMed, Web of Science, Google Scholar, Cochrane were searched, and the following keywords were used: major depressive disorder, antidepressants, suicidality, suicidal behavior, suicidal ideation, young adults, children, side effect, safety, efficacy. Conclusion: By analyzing a large amount of data leads to the conclusion that suicidal ideations, events and the act of suicide itself in rare cases can be triggered by treatment with antidepressants, primarily serotonin reuptake inhibitors. Clinical characteristics such as agitation, ego-dystonic thoughts and impulsivity can be considered warning signs, which is why it is necessary to pay attention to these patients, especially in the first 2 weeks of antidepressant therapy. Data suggest the possibility of preventing adverse suicidal events by combining antidepressant therapy with antipsychotics at the outset of treatment. The antisuicidal effect of ketamine and esketamine in small doses seems particularly intriguing. There is growing evidence of the role of the opioid system in suicidal behavior. Some studies suggest suicidal patients have opioid system dysfunction, which potentially opens up new therapeutic possibilities