Применение атипичного антипсихотика третьего поколения арипипразола (Зилаксера®) в лечении депрессивных состояний, развившихся в рамках шизофрении: исследование эффективности и безопасности

Обоснование: арипипразол в ряду других атипичных антипсихотиков рекомендован как препарат для поддерживающей терапии при шизофрении в случаях, когда у пациента выявляются депрессивные симптомы. При этом депрессии при  шизофрении не указываются в  качестве отдельного показания к  назначению арипипразола. Антидепрессивные свойства препарата учтены лишь в рекомендациях по лечению биполярных депрессий и аугментации терапии депрессий при  рекуррентном депрессивном расстройстве. Отсутствуют работы, характеризующие эффективность и  спектр антидепрессивного действия арипипразола при депрессиях, развивающихся в рамках шизофрении.

Цель исследования: изучить терапевтическую эффективность и  безопасность арипипразола при  аугментации терапии депрессивных состояний средней и тяжелой степени, развившихся в рамках шизофрении.

Пациенты и методы: у 72 больных в возрасте от 18 до 47 лет (все женщины) с депрессивными состояниями тяжестью не менее 17 баллов по шкале Гамильтона в рамках ремиссий приступообразной шизофрении, постшизофренической депрессии и шизотипического расстройства (F20.01 + F32.1–2; F 20.04; F21.3–4 + F32.1–2) изучена эффективность и безопасность аугментации антидепрессивной терапии арипипразолом (Зилаксера®) в  дозе 5–20 мг/сут в  течение 6 нед. Для психометрической оценки депрессии использовались шкала Гамильтона (HDRS-21), шкала общего клинического впечатления (CGI) и шкала оценки побочного действия UKU (UKU Side-Effect Rating Scale).

Результаты: эффективность аугментации антидепрессивной терапии препаратом Зилаксера® была выявлена у большинства пациентов: доля респондеров по шкале HDRS-21 (снижение тяжести депрессивных расстройств на  50% и  более) составила 67,2%, а  по шкале CGI  — 71,4%. При  этом установлено, что группа респондеров имела определенное сходство в плане психопатологической структуры депрессивных состояний.

Заключение: установлено, что у  пациентов, страдающих шизофренией, Зилаксера® обладает отчетливой эффективностью при  аугментации ею антидепрессивной терапии и  характеризуется благоприятным профилем переносимости. Максимальная эффективность препарата в рамках подобного применения наблюдается при депрессивных состояниях с преобладанием негативной аффективности.

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