Transtornos de humor refratários a tratamento

Abstract

A b s t r a c t Objective and Method: Mood disorders are the most prevalent psychiatric disorders. Despite new insights and advances on the neurobiological basis and therapeutic approaches for bipolar disorders and recurrent depression, elevated prevalence of recurrence, persistent sub-syndromal symptoms and treatment resistance are challenging aspects and need to be urgently addressed. The objective of this literature review is to evaluate the current concepts of treatment resistance and refractoriness in mood disorders. Results: Genetic factors, misdiagnosis, use of inappropriate pharmacological approaches, non-compliance and biological/psychosocial stressors account for dysfunctions in mood regulation, thus increasing the prevalence of refractory mood disorders. Regarding available treatments, the use of effective doses during an adequate period followed by augmentation with a second and/or third agent, and finally switching to other agent are steps frequently necessary to optimize efficacy. However, in the treatment-resistant paradigm, drugs mimicking standard strategies, which target preferentially the monoaminergic system, can present reduced therapeutic effects. Thus, the search for new effective treatments for mood disorders is critical to decreasing the overall morbidity secondary to treatment resistance. Conclusion: Emerging strategies targeting brain plasticity pathways or 'plasticity enhancers', including antiglutamatergic drugs, glucocorticoid receptor antagonists and neuropeptides, have been considered promising therapeutic options for difficult-to-treat mood disorders.Descriptors: Depressive disorder, major; Bipolar disorder; Mood disorders; Antidepressive agents; Refractory period, psychologicalResumo Objetivos e Método: Os transtornos de humor estão entre os transtornos psiquiátricos mais prevalentes. Apesar de novas descobertas e avanços no estudo das bases neurobiológicas e abordagens terapêuticas no transtorno bipolar e depressão recorrente, elevadas taxas de recorrência, sintomas subsindrômicos persistentes e refratariedade terapêutica são aspectos clínicos desafiadores e precisam ser abordados. O objetivo desta revisão da literatura é avaliar os conceitos e critérios de resistência e refratariedade ao tratamento, e evidenciar as principais alternativas terapêuticas para transtornos do humor resistentes aos tratamentos disponíveis. Resultados: Fatores genéticos, erro diagnóstico e de tratamento, não-aderência, e estressores biológi-cos e psicossociais podem levar à perda de mecanismos regulatórios e a aumento na prevalência de casos de refratariedade nos transtornos de humor. Com relação aos tratamentos disponíveis, o uso de doses apropriadas, seguido por associação com um segundo ou terceiro fármaco, e após, se indicado, a troca de medicação, são etapas necessárias na busca de melhor eficácia. Entretanto, no paradigma de refratariedade terapêutica, tratamentos atuando em sistemas já conhecidos, especialmente monoaminas, frequentemente apresentam limitada eficácia. Assim, a busca por tratame...

Transtorno afetivo bipolar: perfil farmacoterapêutico e adesão ao medicamento

“…Polypharmacy is frequently used to treat persistent subsyndromic symptoms after monotherapy has failed (20) .…”

Exploratory Study of the Diagnostic Abilities of the Baptista Depression Scale Adult Version (EBADEP-A)

“…It is important to stress that an effective assessment of depression is able to facilitate treatment and promote the improvement of patients, as noted by some authors (Machado-Vieira & Soares, 2007;Pérez-Stable et al, 1990;Razzouk et al, 2009). In this study, for instance, five people who were referred by the psychiatrist for treatment did not meet the scales' criteria of chronicity for depression, showing the need to discuss the complete process of psychological assessment, not only the testing, since patients can be classified as false positives, as stressed by Sox (1996).…”

“…Coupled with this, there is a growing concern among health professionals for the assessment of symptoms to be efficient, both to reduce the number of incorrect diagnoses and to facilitate the treatment of the disorder and follow-up of the disease (Machado-Vieira & Soares, 2007;Pérez-Stable et al, 1990;Razzouk et al, 2009).…”

“…From this perspective, there is a concern to efficaciously assess depressive symptoms in order to reduce the number of incorrect diagnoses, ease treatment and monitor improvement (Machado-Vieira & Soares, 2007;Pérez-Stable, Miranda, Muñoz, & Ying, 1990;Razzouk, Alvarez, & Mari, 2009). It is estimated that from 50% to 75% of people with some mental disorder are overlooked by the health system (Derogatis & Culpepper, 2008).…”

Transtorno afetivo bipolar e terapêutica medicamentosa: adesão, conhecimento e dificuldades de pacientes e familiares

“…Vale ressaltar que os efeitos clínicos dos estabilizadores de humor requerem tratamento crônico, consistente com o tempo necessário para que ocorra a cascata de eventos intracelulares e subseqüente modulação da expressão gênica (KAPCZINSKI et al, 2004). Ainda, por ser o TAB caracterizado por diferentes fases, alguns agentes podem ser eficazes somente em uma fase do transtorno, sendo a polifarmácia freqüentemente utilizada para tratar os sintomas subsindrômicos persistentes após o fracasso da monoterapia (MACHADO-VIEIRA;SOARES, 2007).…”