Gabriel Nowak, Andrzej Pilc, Ewa Poleszak
Współczesna farmakoterapia lęku i depresji
Current pharmacotherapy of anxiety and depression. Mental disorders are the major health and financial problem in Europe. Among them depression and anxiety are the most prevalent ones. There is also a marked comorbidity between depression and anxiety. Antidepressant therapy includes drugs with a remarkable structural diversity as well as nonpharmacological interventions. Most antidepressants are "monoamine based" effecting the inhibition of reuptake/metabolism of serotonin, noradrenaline (and/or dopamine). Moreover, atypical antidepressants, which are devoid of inhibiting properties of monoamine reuptake/metabolism, are currently in use. This group includes antagonists of different receptors, neuroleptics with antidepressant properties and "mood-stabilizing" agents. The non-pharmacological treatments like electroconvulsive shock, sleep deprivation, phototherapy and psychotherapy are also applied in the therapy of affective disorders. Many hypotheses have been proposed concerning mechanism(s) of antidepressant action. Recently, adaptation in glutamate system, in neurotrophins expression and induction of neurogenesis process as candidates for main target of antidepressants treatment are under extensive evaluation. Anxiolytic drugs are also structurally very diverse. Several antidepressants are used also to treat anxiety. However, the only drugs, which are effective after a single dose, are benzodiazepines, which are not free from adverse actions. New drugs, which are not based on monoaminergic transmission, are urgently needed to treat both anxiety and depression.