medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-11-70-81medsovet-5755Research ArticleНЕВРОЛОГИЯNEUROLOGYСовременные подходы к фармакотерапии послеродовой депрессииModern approaches to the pharmacotherapy of postpartum depressionhttps://orcid.org/0000-0002-9605-8527ОвчинниковА. В.OvchinnikovA. V.

Овчинников Алексей Валерьевич, клинический ординатор

119034, Москва, Кропоткинский пер., д. 23

Aleksey V. Ovchinnikov, Resident Medical Practitioner

23, Kropotkinskiy Per., Moscow, 119034

ovchinnikov.alexy@yandex.ruhttps://orcid.org/0000-0002-6018-402XВазагаеваТ. И.VazagaevaT. I.

Вазагаева Тамара Иродионовна, к.м.н., старший научный сотрудник отделения новых средств и методов терапии Отдела пограничной психиатрии

119034, Москва, Кропоткинский пер., д. 23

Tamara I. Vazagaeva, Cand. of Sci. (Med.), Senior Researcher, New Therapies and Treatment Modalities Unit, Boundary Psychiatry Department

23, Kropotkinskiy Per., Moscow, 119034

vazagaeva@mail.ruНациональный медицинский исследовательский центр психиатрии и наркологии им. В.П. СербскогоРоссияV.P. Serbsky National Medical Research Centre for Psychiatry and NarcologyRussian Federation2020060820200117081Copyright © Овчинников А.В., Вазагаева Т.И., 20202020Овчинников А.В., Вазагаева Т.И.Ovchinnikov A.V., Vazagaeva T.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5755

Послеродовая или постнатальная депрессия (ПРД) является распространенным расстройством, имеющим серьезные негативные последствия для здоровья женщины и повышающим риск нарушения эмоционального, социального и когнитивного развития ребенка. В фармакотерапии ПРД существует ряд нерешенных проблем, обусловленных недостатком доказательных сведений в отношении как эффективности, так и безопасности лекарственных средств. В данном обзоре рассмотрены современные представления о подходах к диагностике и лечению пациенток с ПРД в рамках рекуррентной депрессии и биполярного расстройства, особенности проведения фармакотерапии в послеродовом периоде в зависимости от проявлений и течения заболевания. В соответствии с существующими рекомендациями в лечении ПРД должны применяться те же стандартные подходы, что и в терапии депрессий, не связанных с беременностью и родами, при этом в большинстве случаев рекомендуется отказ от грудного вскармливания, что несколько противоречит литературным данным. Результаты немногочисленных клинических исследований указывают на совместимость некоторых психотропных препаратов с кормлением грудью в связи с их низкой способностью проникать в грудное молоко и редкостью возникновения нежелательных явлений у младенцев. В этом отношении препаратом первого выбора среди антидепрессантов (АД) считается сертралин, а среди нормотимических средств – кветиапин и вальпроат, однако ограниченный объем данных не позволяет делать окончательные выводы о краткосрочных и долгосрочных рисках для детей. Также в статье обозначены перспективные направления в разработке новых антидепрессивных препаратов для лечения ПРД на основе нейростероидов, механизм действия которых преимущественно связан с модулирующим влиянием на ГАМКергическую нейротрансмиссию.

Postpartum or postnatal depression (PDD) is a common disorder that has serious negative effects on a woman’s health and increases the risk for a child’s emotional, social, and cognitive development outcomes. There are a few unresolved problems in the PDD pharmacotherapy caused by the lack of evidence about drug safety and effectiveness. This review provides a timely update on the current understanding of approaches to the diagnosis and treatment of patients with PDD as part of recurrent depression and bipolar disorder, the features of pharmacotherapy in the postpartum period depending on the manifestations and course of the disease. In accordance with the current guidelines, the treatment of PDD requires the use of the same standard approaches, as in the treatment of depression not associated with pregnancy and childbirth, while it is recommended to refuse breastfeeding in most cases, which runs somewhat contrary to the literature. Several clinical studies have shown that some psychotropic drugs are safe to use in breastfeeding mothers as they demonstrate low transfer into breast milk and rarely cause adverse events in infants. With this respect, sertraline is regarded as the first choice among antidepressants (AD), and quetiapine and valproate among normotimics, however, the limited amount of data does not allow us to make final conclusions about short-term and long-term risks for children. The article also outlines promising directions in the development of new neurosteroid-based antidepressant drugs for the treatment of PDD. Their mechanism of action is mainly associated with a modulating effect on GABAergic neurotransmission.

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The authors declare that there are no conflicts of interest present.