Jarema Marek, Dudek Dominika, Czernikiewicz Andrzej
III Klinika Psychiatryczna, IPiN, Warszawa.
Zakład Zaburzeń Afektywnych, Katedra Psychiatrii UJ CM.
Psychiatr Pol. 2014 Nov-Dec;48(6):1105-16. doi: 10.12740/PP/31215.
Cognitive deficits constitute an integral part of clinical picture of depression, but often not enough attention has been paid to these deficits, mainly because of the presumption that they are secondary to typical depressive symptoms. It is considered that cognitive impairment is one of the main causes of depressive patients' poor functioning. Cognitive deficits are observed already in the first depressive episode. They may correlate with the severity of depression, with the patient's age and level of education. They may persist regardless of the improvement of depression during treatment. Cognitive deficits in depression are divided into "cold" which are not related to emotions, and "hot" - related to emotions. The "cold" deficits are supposed not to respond to antidepressants and seem to persist even in clinical remission. Vortioxetine is a novel antidepressant with a unique mechanism of action: it acts through the serotonine reuptake inhibition, but works also as 5HT(1A) agonist, as well as partial agonist of the 5HT(1B) receptor and antagonist of the 5HT(1D), 5HT(3) and 5HT(7) receptors. In preclinical studies vortioxetine showed the normalization of serotoninergic, noradrenergic, and dopaminergic transmission, additionally through GABA-ergic and glutaminergic effects. It has antidepressive property, it proved to be efficacious in various types of depression (severe, depression with anxiety, and depression in elderly); it also proved to be efficacious in those patients who did not respond sufficiently to SSRIs and SNRIs treatment. Vortioxetine is also beneficial for cognitive functions in depressed patients.
认知缺陷是抑郁症临床症状的一个组成部分，但这些缺陷往往没有得到足够的关注，主要是因为人们认为它们是典型抑郁症状的继发症状。认知障碍被认为是抑郁症患者功能不佳的主要原因之一。在首次抑郁发作时就可观察到认知缺陷。它们可能与抑郁症的严重程度、患者的年龄和教育水平相关。无论治疗期间抑郁症是否改善，这些缺陷都可能持续存在。抑郁症中的认知缺陷分为与情绪无关的“冷”缺陷和与情绪相关的“热”缺陷。“冷”缺陷被认为对抗抑郁药无反应，甚至在临床缓解期似乎仍会持续。伏硫西汀是一种具有独特作用机制的新型抗抑郁药：它通过抑制5-羟色胺再摄取起作用，但同时也是5-羟色胺1A（5HT(1A)）受体激动剂，以及5-羟色胺1B（5HT(1B)）受体部分激动剂和5-羟色胺1D（5HT(1D)）、5-羟色胺3（5HT(3)）和5-羟色胺7（5HT(7)）受体拮抗剂。在临床前研究中，伏硫西汀显示出5-羟色胺能、去甲肾上腺素能和多巴胺能传递的正常化，此外还通过γ-氨基丁酸能和谷氨酸能发挥作用。它具有抗抑郁特性，已被证明对各种类型的抑郁症（重度、伴有焦虑的抑郁症和老年抑郁症）有效；它对那些对选择性5-羟色胺再摄取抑制剂（SSRI）和5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRI）治疗反应不足的患者也有效。伏硫西汀对抑郁症患者的认知功能也有益处。
