Tratamento medicamentoso da depressão maior refratária
Palavras-chave:
Antidepressivos, depressão, transtorno depressivo resistente a tratamento, ensaios clínicos controlados como assunto, metanáliseResumo
Introdução: Aproximadamente um terço dos pacientes com depressão não atingem remissão. As estratégias medicamentosas mais comumente utilizadas para a abordagem da depressão resistente são a substituição, a potencialização e a combinação de antidepressivos. Objetivo: Realizar revisão narrativa da literatura em relação a essas estratégias. Metodologia: Buscas sistemáticas no PubMed, Cochrane Library e Lilacs de estudos sobre o tratamento medicamentoso da depressão refratária foram realizadas, considerando artigos publicados até 30 de agosto de 2015. Resultados: Foram selecionados 11 artigos, sendo 6 sobre substituição, 3 acerca de potencialização e 2 sobre combinação de antidepressivos. Conclusão: As estratégias medicamentosas para o tratamento da depressão refratária foram pouco estudadas. O número de ensaios clínicos é pequeno e as limitações metodológicas são significativas. Evidências de eficácia são observadas apenas na potencialização com o lítio, hormônio tireoidiano e alguns antipsicóticos de segunda geração. Ensaios controlados com placebo, com número adequado de pacientes e de curto e longo prazo, estudos para identificação de estratégias mais eficazes em subgrupos e análises de custo-benefício são necessários.
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