medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-282medsovet-9307Research ArticleНЕРВНО-ПСИХИЧЕСКИЕ РАССТРОЙСТВАNEUROPSYCHIATRIC DISORDERSАнтидепрессанты первой линии: селективные ингибиторы обратного захвата серотонинаFirst-line antidepressants: selective serotonine reuptake inhibitorshttps://orcid.org/0000-0002-4494-149XСиволапЮ. П.SivolapYu. P.

Сиволап Юрий Павлович - д.м.н., профессор кафедры психиатрии, психотерапии и психосоматической патологии факультета непрерывного медицинского образования.

117198, Москва, ул. МиклухоМаклая, д. 6

Yury P. Sivolap - Dr. Sci. (Med.), Professor of the Department of Psychiatry, Psychotherapy and Psychosomatic Pathology, Faculty of Continuing Medical Education.

6, Miklukho-Maklai St., Moscow, 117198

yura-sivolap@yandex.ruhttps://orcid.org/0000-0001-5938-0202ПортноваА. А.PortnovaA. A.

Портнова Анна Анатольевна - д.м.н., главный научный сотрудник.

119602, Москва, Мичуринский проспект, д. 74

Anna A. Portnova - Dr. Sci. (Med.), Chief Researcher.

74, Michurinsky Ave., Moscow, 119602

aapserbsky@yandex.ruРоссийский университет дружбы народов имени Патриса ЛумумбыРоссияPeoples’ Friendship University of Russia named after Patrice LumumbaRussian FederationНаучно-практический центр детской психоневрологииРоссияResearch and Clinical Center of Pediatric PsychoneurologyRussian Federation2025080820250126472Copyright © Сиволап Ю.П., Портнова А.А., 20252025Сиволап Ю.П., Портнова А.А.Sivolap Y.P., Portnova A.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9307

Антидепрессанты широко используются в психиатрии и общей клинической практике и относятся к категории самых часто назначаемых лекарственных средств. Антидепрессантами первой линии служат селективные ингибиторы обратного захвата серотонина (СИОЗС), заменившие в этом качестве в последние десятилетия трициклические антидепрессанты (ТЦА), сопоставимые с селективными ингибиторами обратного захвата серотонина по эффективности, но значительно уступающие им по переносимости и безопасности. Основными показаниями к назначению антидепрессантов служат депрессия и тревожные расстройства. Кроме того, отдельные антидепрессанты применяются в лечении обсессивно-компульсивного расстройства, посттравматического расстройства, бессонницы и других расстройств. Особое место среди селективных ингибиторов обратного захвата серотонина занимает флувоксамин, отличительные особенности которого составляют хорошая переносимость, избирательное влияние на симптомы обсессивно-компульсивного расстройства, в т. ч. у детей и подростков, что в сочетании с высокой безопасностью позволяет назначать его детям с восьми лет, а также самое высокое среди селективных ингибиторов обратного захвата серотонина сродство к σ1-рецепторам, создающее флувоксамину особые преимущества в улучшении когнитивных функций, лечении психотической депрессии и психических расстройств, осложненных агрессивным поведением. Благодаря хорошей переносимости флувоксамин считается наиболее безопасным антидепрессантом для пожилых пациентов и пациентов с сердечно-сосудистыми болезнями. Свойственная флувоксамину заметная способность уменьшать проявления нейровоспаления создает ему особые преимущества в лечении большого депрессивного расстройства и позволяет предполагать определенные перспективы в предупреждении и лечении нейродегенеративных заболеваний, включая болезнь Альцгеймера, болезнь Паркинсона и болезнь Гентингтона.

Antidepressants are widely used in psychiatry and general clinical practice and are among the most commonly prescribed medications. First-line antidepressants are selective serotonin reuptake inhibitors (SSRIs), which in recent decades have replaced tricyclic antidepressants (TCAS), which are comparable to SSRIs in efficacy but significantly inferior in tolerability and safety. The main indications for prescribing antidepressants are depression and anxiety disorders. In addition, certain antidepressants are used in the treatment of obsessive-compulsive disorder, post-traumatic stress disorder, insomnia and other disorders. Fluvoxamine occupies a special place among SSRIs, the distinctive features of which are good tolerability, selective effect on the symptoms of obsessive-compulsive disorder, including in children and adolescents, which, combined with high safety, allows it to be prescribed to children from the age of eight, as well as the highest affinity for σ1-receptors among SSRIs, which creates special properties of fluvoxamine, benefits in improving cognitive functions, treating psychotic depression and mental disorders complicated by aggressive behavior. Due to its good tolerability, fluvoxamine is considered the safest antidepressant for elderly patients and patients with cardiovascular diseases. Fluvoxamine’s remarkable ability to reduce neuroinflammation creates special advantages for it in the treatment of major depressive disorder and suggests certain prospects for the prevention and treatment of neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease and Huntington’s disease.

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