Neurosteroidowa terapia zastępcza w leczeniu depresji poporodowej z zastosowaniem Brexanolonu

Michał Wilk; Patryk Walocha; Martyna Szlenk; Julia Cieśla; Maciej Smreczak

Neurosteroidowa terapia zastępcza w leczeniu depresji poporodowej z zastosowaniem Brexanolonu

Autorzy

Michał Wilk - Wydział Nauk Medycznych w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach; Patryk Walocha - 1. Studenckie Koło Naukowe im. Prof. Zbigniewa Religi przy Katedrze Biofizyki, Wydział Nauk Medycznych w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach ; Martyna Szlenk - 1. Studenckie Koło Naukowe im. Prof. Zbigniewa Religi przy Katedrze Biofizyki, Wydział Nauk Medycznych w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach ; Julia Cieśla - 1. Studenckie Koło Naukowe im. Prof. Zbigniewa Religi przy Katedrze Biofizyki, Wydział Nauk Medycznych w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach ; Maciej Smreczak - 1. Studenckie Koło Naukowe im. Prof. Zbigniewa Religi przy Katedrze Biofizyki, Wydział Nauk Medycznych w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach

Słowa kluczowe:

depresja poporodowa, brexanolon, Zulresso, allopregnanolon, neurosteroid

Streszczenie

Depresja poporodowa (ang. postpartum depression PPD) jest uznawana za najpoważniejsze zaburzenie psychiatryczne w okresie poporodowym, wpływające zarówno na matkę jak i rozwój jej nowonarodzonego dziecka. Mimo to do tej pory nie posiada ono oddzielnej klasyfikacji wg DSM-5 a kryteria jego rozpoznania pozostają rozbieżne. Uważa się że PDD może dotyczyć nawet 10 – 20% kobiet w okresie poporodowym, jednak podejrzewa się że dane te są znacząco niedoszacowane. Pełny mechanizm rozwoju depresji poporodowej jest złożony i nie do końca poznany. Patofizjologia schorzenia obejmuje zmiany hormonalne, zaburzenia przewodnictwa GABA-ergicznego, wpływ komponenty immunologicznej oraz predyspozycje genetyczne. Aktualne rekomendacje zalecają badanie screeningowe i wstępną oceną PDD przy użyciu kwestionariusza EPDS (ang. Edinburgh Postnatal Depression Scale). Dotychczasowe możliwości terapeutyczne obejmują modyfikację stylu życia, wsparcie psychosocjalne, psychoterapię, farmakoterapię oraz terapie somatyczne. Psychoterapia jest zalecana jako leczenie pierwszego rzutu, jednocześnie będąc metodą preferowaną przez pacjentki. Leczenie farmakologiczne opiera się na zastosowaniu SSRI, szczególnie sertraliny dla której zastosowanie w tym wskazaniu zostało najlepiej udokumentowane. Przełom w leczeniu PDD może stanowić brexanolon (Zulresso) będący syntetycznym odpowiednikiem neuroaktywnego steroidu – allopregnanolonu, dodatniego modulatora allosterycznego receptorów GABA-A. Liczne obserwacje kobiet z zaburzeniami depresyjnymi wykazały znaczące obniżenie poziomu allopregnanolonu w surowicy, co stanowiło punkt wyjścia dla idei neurosteroidowej terapii zastępczej. Brexanolon podawany jest w formie 60-godzinnego wlewu dożylnego w ściśle określonych dawkach. Wyniki badań klinicznych oraz metaanaliz potwierdzają skuteczność preparatu, który wykazuje szybkie działanie już po 24 godzinach. Do najczęściej zgłaszanych działań niepożądanych leku należą zawroty głowy i senność, skrajnie sedacja. Za istotną wadę Zulresso należy uznać wysoką cenę terapii, co może w przyszłości ulec zmianie w kontekście badań koncernu nad tańszym odpowiednikiem (SAGE-217). Celem niniejszej pracy jest zobrazowanie czytelnikowi problematyki depresji poporodowej w kontekście nowej metody terapeutycznej z zastosowaniem brexanolonu.

Bibliografia

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