İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı

BUTURAK, Şadiye Visal; BAKAR, BULENT

İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı

Şadiye Visal BUTURAK, (Kırıkkale Üniversitesi, Tıp Fakültesi, Psikiyatri Anabilim Dalı, Kırıkkale, Türkiye)

BÜLENT BAKAR (Kırıkkale Üniversitesi, Tıp Fakültesi, Nöroşirürji Anabilim Dalı, Kırıkkale, Türkiye)

Journal of Mood Disorders

49 5

Yıl: 2014 Cilt: 4 Sayı: 4 Sayfa Aralığı: 164 - 174 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı

Öz:

Amaç: Tedaviye direnç ile ilgili değişik tedavi yöntemleri ilerisürülmesine rağmen bir grup hastada bu alternatif yöntemlerleklinik başarı sağlanamamaktadır. Tedaviye dirençli epilepsitedavisinde vagus sinir uyarımı (VSU) tedavisinin erken gözlemleri arasında genel mizaç düzelmelerinin gözlenmesi bu tedaviyönteminin bu grup hasta da etkili olabileceğini akla getirmiştir.Bu konu ile ilgili deneysel ve klinik çalışmalar yapılmış ve butekniğin depresyon tedavisinde seçenek olarak kullanılabileceği gösterilmiştir. Bu derleme çalışmasında tedaviye dirençlimajör depresif bozukluklarda alternatif tedavi yöntemi olarakkullanılan VSUnun etki mekanizmaları ve etkinliği incelenmeyeçalışılmıştır. Yöntem: Bu derleme yazısında Medline/Index Medicus(PubMED)da yayınlanan VSU tedavisinin uygulama yöntemleri,etki mekanizmaları, tedaviye dirençli depresif hecme tedavisin- de etkinliği ve güvenirliği ile ilgili çalışmalar gözden geçirilmiştir. Bulgular: VSUnun tedaviye dirençli depresif dönemlerdenasıl etki ettiği ile ilgili literatürde çok fazla sayıda çalışmavardır. Ancak bu çalışmalarda beynin hangi bölgesine nasıl etkiettiği tam olarak gösterilememiştir. VSU yönteminin tedaviyedirençli depresif dönemlerde etkinliği ve güvenirliği ile ilgilifarklı yöntemler ve çalışma desenleri kullanılarak araştırmalaryapılmıştır. Bunların bir kısmında VSUnun tedaviye dirençlidepresif dönemlerin tedavisinde yanıt ve iyileşme oranlarındaartış yaptığı gösterilmişken bazı çalışmalarda ise sadece tedaviye yanıt oranlarında artışa neden olduğu saptanmıştır. Buçalışmalarda araştırma grubuna alınan hastaların büyük kısmınıtedaviye dirençli depresif dönemler geçiren tek uçlu bozukluğuolan hastalar oluştururken daha az kısmını iki uçlu bozukluğuolan hastalar oluşturmuştur. Çalışmalarda VSU uygulanan hastalarda en sık bildirilen yan etkiler ameliyat yerinde ağrı, sesdeğişikliği, boyun ağrısı, baş ağrısı, öksürük, yutma güçlüğü venefes darlığı olmuştur. VSU etkinliği ile ilgili sonuçlar arasındafarklılıkların çalışmalarda kullanılan yöntemsel farklılıklardan,araştırmaya alınan hastaların saf bir grup olmamasından, VSUile birlikte kullanılan geleneksel tedavilerin farklı olmasındanve bunların sonuçlar üzerine etkilerinin dışlanmamasındankaynaklandığı düşünülmüştür. Çalışmalarda iki uçlu bozukluğuolanların sayısının az olduğu için bu alanda VSUnun etkinliğineve güvenirliğine dair örneklem sayısının daha fazla olduğuaraştırmaların yapılmasının uygun olacağı ileri sürülmüştür. Sonuç: Literatür incelendiğinde VSUnun tedaviye dirençli depresyon dönelerinde kullanımı etkin ve güvenilir gibi görünmekle birlikte bu yöntemi daha yaygın olarak kullanabilmek içinbu konu ile ilgili daha fazla kontrollü ileriye dönük çalışmayaihtiyaç olduğu görülmektedir.

Anahtar Kelime:

Konular: Psikiyatri

A new therapy modality for treatment-resistant depression: Vagal nerve stimulation

Öz:

Objective: Although new treatment modalities arerecommended for the treatment resistant depression, ithas been estimated that some depressive episodes treatedfor an adequate duration with recommended dose of anantidepressant exhibit treatment resistance. Direct evidencesupporting a role for the vagal nerve stimulation (VNS)therapy in depression came from early observation of moodimprovement in treatment resistant epileptic patients whowere performed VNS. Results of the clinical and experimentalstudies recommended that VNS therapy could be a choice forlong-term treatment of chronic or recurrent treatment resistantdepression (TRD). The aim of this study was to review theliterature which evaluates the affectivity and mechanism ofthe VNS which have been used as an alternative therapymodality in the treatment resistant major depressive disorders. Method: Medline/ Index Medicus (PubMED) was searched andthe reports which investigated the properties of the VNS (suchas application procedures, mechanisms of effect, therapeuticaffectivity and reliability of VNS in chronic or recurrent TRDepisodes) were reviewed in a wide perspective in this article. Results: It has been reported in several studies that largenumber of patients receiving conventional treatment couldnot show full remission of depressive episodes, and the resultsof these studies support that new therapy modalities areneeded. Numerous studies had been conducted regarding theeffect mechanisms of VNS in treatment-resistant depressiveepisodes. However, in these studies which area of the brain-and how- was affected not fully understood. The effectivenessand the reliability of the VNS methods in intractable depressiveepisodes have been investigated by using different methodsand study design. In some of these VNS studies for treatmentof TRD episodes, showed an increase in the rate of treatmentresponse and remission; however, some studies showed anincrease only in the rate of treatment response. In thesestudies, the research group received a large portion of patintswith unipolar disorder who had TRD episodes in general, andless portion of patients were bipolar disorders. And, the authorssuggested future studies contained large sample size, becausetheir study samples, which were conducted to investigate theeffectiveness and reliability of VNS, consisted of relatively smallnumber of the patients with bipolar disorder. In studies, themost commonly reported side effects in patients treated withVNS were incision side pain, hoarseness, neck pain, headache,cough, difficulty in swallowing, and shortness of breath. Conclusion: VNS in TRD episodes may seem an efficient andreliable treatment method to use, but this method more widely onthis subject to be able to use more controlled studies are needed.

Anahtar Kelime:

Konular: Psikiyatri

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

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APA	BUTURAK Ş, BAKAR B (2014). İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı. , 164 - 174.
Chicago	BUTURAK Şadiye Visal,BAKAR BULENT İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı. (2014): 164 - 174.
MLA	BUTURAK Şadiye Visal,BAKAR BULENT İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı. , 2014, ss.164 - 174.
AMA	BUTURAK Ş,BAKAR B İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı. . 2014; 164 - 174.
Vancouver	BUTURAK Ş,BAKAR B İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı. . 2014; 164 - 174.
IEEE	BUTURAK Ş,BAKAR B "İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı." , ss.164 - 174, 2014.
ISNAD	BUTURAK, Şadiye Visal - BAKAR, BULENT. "İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı". (2014), 164-174.

APA	BUTURAK Ş, BAKAR B (2014). İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı. Journal of Mood Disorders, 4(4), 164 - 174.
Chicago	BUTURAK Şadiye Visal,BAKAR BULENT İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı. Journal of Mood Disorders 4, no.4 (2014): 164 - 174.
MLA	BUTURAK Şadiye Visal,BAKAR BULENT İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı. Journal of Mood Disorders, vol.4, no.4, 2014, ss.164 - 174.
AMA	BUTURAK Ş,BAKAR B İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı. Journal of Mood Disorders. 2014; 4(4): 164 - 174.
Vancouver	BUTURAK Ş,BAKAR B İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı. Journal of Mood Disorders. 2014; 4(4): 164 - 174.
IEEE	BUTURAK Ş,BAKAR B "İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı." Journal of Mood Disorders, 4, ss.164 - 174, 2014.
ISNAD	BUTURAK, Şadiye Visal - BAKAR, BULENT. "İlaç Tedavisine Dirençli Depresyonda Bir Alternatif Tedavi Yöntemi: Vagal Sinir Uyarımı". Journal of Mood Disorders 4/4 (2014), 164-174.