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Современные подходы к фармакотерапии послеродовой депрессии

https://doi.org/10.21518/2079-701X-2020-11-70-81

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Аннотация

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.

Об авторах

А. В. Овчинников
Национальный медицинский исследовательский центр психиатрии и наркологии им. В.П. Сербского
Россия

Овчинников Алексей Валерьевич, клинический ординатор

119034, Москва, Кропоткинский пер., д. 23



Т. И. Вазагаева
Национальный медицинский исследовательский центр психиатрии и наркологии им. В.П. Сербского
Россия

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

119034, Москва, Кропоткинский пер., д. 23



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Для цитирования:


Овчинников А.В., Вазагаева Т.И. Современные подходы к фармакотерапии послеродовой депрессии. Медицинский Совет. 2020;(11):70-81. https://doi.org/10.21518/2079-701X-2020-11-70-81

For citation:


Ovchinnikov A.V., Vazagaeva T.I. Modern approaches to the pharmacotherapy of postpartum depression. Meditsinskiy sovet = Medical Council. 2020;(11):70-81. (In Russ.) https://doi.org/10.21518/2079-701X-2020-11-70-81

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