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LA QUETIAPINA TIENE EFICACIA ANTIDEPRESIVA
(especial para SIIC © Derechos reservados)
La eficacia antidepresiva de la quetiapina se demuestra sobre la base de información clínica y farmacodinámica. La autorización del uso de quetiapina en pacientes con trastornos bipolares, como monoterapia o complemento de otras drogas, se debió en una primera instancia a la eficacia observada en estudios a doble ciego, aleatorizados y controlados.
Autor:
Chiara Rovera
Columnista Experto de SIIC

Institución:
Fondazione IRCCS Ospedale Maggiore Policlinico


Artículos publicados por Chiara Rovera
Coautores
Chiara Di Pace* Silvia Paletta* Alessandra Reggiori* Valentina Ciappolino* Massimo Carlo Mauri** Alfredo Carlo Altamura** 
Médica, Fondazione IRCCS Ospedale Maggiore Policlinico, Milán, Italia*
Médico, Fondazione IRCCS Ospedale Maggiore Policlinico, Milán, Italia**

Resumen
La presente revisión muestra la eficacia antidepresiva de la quetiapina (QTP) sobre la base de información farmacodinámica y clínica. La QTP se encuentra aprobada por la FDA estadounidense para el tratamiento de los pacientes con esquizofrenia y trastornos bipolares. En particular, la QTP se encuentra indicada para el tratamiento de los episodios depresivos asociados con el trastorno bipolar; los episodios maníacos o mixtos asociados con el trastorno bipolar tipo I, como monoterapia o como adyuvante del litio o del divalproato; así como en la terapia de mantenimiento de los pacientes con trastorno bipolar tipo I en combinación con el litio o el divalproato. Por otro lado, la European Medicines Agency (EMEA) indicó el uso de QTP en pacientes con esquizofrenia y para el tratamiento y la prevención de los pacientes con trastorno bipolar: en particular para el tratamiento de los episodios maníacos moderados a graves y de los episodios de depresión mayor en pacientes con trastorno bipolar; también para la prevención de las recurrencias de los episodios maníacos o depresivos en pacientes con trastorno bipolar y antecedentes de respuesta a la QTP. La QTP también puede utilizarse como complemento del tratamiento de los pacientes con episodios de depresión mayor que presentan una respuesta subóptima a otros antidepresivos. La autorización del uso de QTP en pacientes con trastornos bipolares, como monoterapia o como complemento de otras drogas, se debió en primer lugar a la eficacia observada en estudios a doble ciego, aleatorizados y controlados. Además, muchos síntomas de depresión se deben a la disminución de la neurotransmisión dopaminérgica en la corteza prefrontal (CPF). Se cree que el metabolito activo de la QTP, la norquetiapina, facilita la liberación de dopamina en la CPF debido al antagonismo 5HT2A y 5HT2C y resulta útil para aliviar los síntomas depresivos en pacientes con trastornos del estado de ánimo.

Palabras clave
quetiapina, metabolito activo, antidepresivos, norquetiapina, antipsicóticos


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Abstract
This review shows the antidepressants efficacy of quetiapine (QTP) on the basis of pharmacodynamics and clinical data. QTP is approved by the american FDA for the treatment of schizophrenia and bipolar disorders. In particular QTP is indicated for the treatment of depressive episodes associated with bipolar disorder, manic or mixed episodes associated with bipolar I disorder as either monotherapy or adjunct therapy to lithium or divalproex and in maintenance treatment of bipolar I disorder as adjunct therapy to lithium or divalproex. On the other hand European Medicines Agency (EMEA) indicates the use of QTP in schizophrenia and in the treatment and prevention of bipolar disorder: in particular in the treatment of moderate to severe manic episodes in bipolar disorder and major depressive episodes in bipolar disorder; prevention of recurrence of manic or depressed episodes in patients with bipolar disorder who previously responded to QTP. QTP can also be used as add-on to ongoing treatment for major depressive episodes in patients with major depressive disorder who have had sub-optimal response to treatment with other antidepressants. The licensing of QTP in bipolar disorders either as monotherapy or adjunctive to other medications, was firstly due to its efficacy in double blind, randomized, controlled trials. Moreover many symptoms of depression result from decreased dopamine neurotransmission in the prefrontal cortex (PFC). It is believed that the active metabolite of QTP, norquetiapine, with its 5HT2A and 5HT2C antagonism facilitates dopamine release in PFC and is instrumental in relieving the depressive symptoms in mood disorders.

Key words
quetiapine, active metabolite, antidepressants, noquetiapine, antipsychotic


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Resumen del idioma nativo
Questa review discute l’efficacia della quetiapina (QTP), come antidepressivo, sulla base dei dati disponibili di farmacodinamica e clinici. La QTP e’ un antipsicotico atipico il cui utilizzo clinico e’ stato approvato dalla Food and Drug Administration americana (FDA) nella schizofrenia e nel disturbo bipolare. In particolare la QTP e’ indicata per il trattamento degli episodi depressivi associati al disturbo bipolare e negli episodi maniacali o misti associati al disturbo bipolare I sia in monoterapia che in terapia associata ai sali di litio o all’acido valproico e nel mantenimento del disturbo bipolare come terapia aggiuntiva ai sali di litio o all’acido valproico. D’altro canto l’Agenzia per i Farmaci Europea (EMEA) ha indicato l’uso della QTP nella schizofrenia e nel trattamento e prevenzione del disturbo bipolare: in particolare nel trattamento degli episodi moderati e severi degli episodi maniacali nel disturbo bipolare e negli episodi depressivi maggiori nel disturbo bipolare che aveva risposto in precedenza alla QTP. La QTP puo’ essere anche utilizzata in aggiunta al trattamento dell’episodio depressivo maggiore nei pazienti affetti da disturbo depressivo maggiore che avevano avuto una risposta sub-ottimale al trattamento con antidepressivi. L’autorizzazione all’uso della QTP nel disturbo bipolare sia in monoterapia che in associazione ad altri farmaci era inizialmente data dalla sua dimostrazione di efficacia in studi controllati, in doppio cieco, randomizzati. Per altro, molti sintomi depressivi risultano legati ad una riduzione della trasmissione dopaminergica nella corteccia prefrontale (PFC). E’ stato dimostrato che il metabolita attivo della QTP, la norquetiapina, grazie alla sua attivita’ antagonista a livello dei recettori 5HT2A e 5HT2C, faciliti il rilascio di dopamina a livello della PFC, in tal modo risultando attiva sui sintomi depressivi nei disturbi dell’umore.

Palabras clave del idioma nativo
quetiapina, metabolita attivo, antidepressivos, norquetiapina, antipsicoticos


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Especialidades
Principal: FarmacologíaSalud Mental
  Relacionadas: Atención PrimariaMedicina FarmacéuticaSalud Pública

Enviar correspondencia a:
Massimo Carlo Mauri, 20122, Via F. Sforza 35, Milán, Italia
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Especialidad principal:
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