DOS AÑOS DESPUES DE LA APARICION DE LOS ANTIPSICOTICOS DE SEGUNDA GENERACION, "LA CANCION SIGUE SIENDO LA MISMA"
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DOS AÑOS DESPUES DE LA APARICION DE LOS ANTIPSICOTICOS DE SEGUNDA GENERACION, "LA CANCION SIGUE SIENDO LA MISMA"

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Si se considera indispensable tratar con antipsicóticos de segunda generación a los pacientes con trastorno bipolar, se debe preferir la olanzapina, a pesar de sus limitaciones en cuanto a seguridad, porque esta droga presenta el mayor número de estudios bien diseñados con resultados tranquilizadores en cuanto a su eficacia.
gentile9.jpg Autor:
Salvatore Gentile
Columnista Experto de SIIC

Institución:
Mental Health Center Nº 4


Artículos publicados por Salvatore Gentile
Recepción del artículo
19 de Diciembre, 2008
Aprobación
27 de Enero, 2009
Primera edición
16 de Junio, 2009
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
A pesar del entusiasmo creciente por el uso de los antipsicóticos de segunda generación (ASG) en pacientes bipolares, una revisión sistemática publicada en 2007 generó varias dudas sobre la efectividad de estos medicamentos, tanto para el tratamiento de episodios agudos como para la prevención de los cambios del estado de ánimo. Existe, por lo tanto, la necesidad de verificar si durante los dos últimos años se han realizado nuevos estudios que validen la inclusión de los ASG entre las opciones farmacológicas de primera línea para el tratamiento del trastorno bipolar. Sin embargo, desafortunadamente, los estudios más recientes resultaron inadecuados cualtitava y cuantitativamente para aminorar las dudas sobre la seguridad y eficacia de los ASG en esos pacientes. Por esta razón, en la actualidad, los ASG deberían considerarse agentes de cuarta línea en todas las diferentes fases que caracterizan el curso fluctuante de este trastorno. De hecho, el uso de estos fármacos debería sólo considerarse en el caso de que los estabilizadores del estado de ánimo, los anticonvulsivos, los antidepresivos o los antipsicóticos de primera generación (APG) fallaran. Si a pesar de ello los clínicos insisten que es indispensable el tratamiento de estos pacientes con ASG, se debería preferir a la olanzapina, a pesar de sus limitaciones en cuanto a seguridad, porque esta droga presenta el mayor número de estudios bien diseñados con resultados tranquilizadores en cuanto a su eficacia.

Palabras clave
neurolépticos, antipsicóticos atípicos/segunda generación, risperidona, quetiapina, olanzapina, ziprasidona, aripiprazol, trastorno afectivo/bipolar, manía, depresión, efectividad, seguridad, eficacia, tasa de interrupción


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Abstract
Despite the growing enthusiasm for the effective use of second-generation antipsychotics (SGAs) in bipolar patients, a systematic review article published in 2007 raised several concerns about the effectiveness of such medications both for treating acute mood episodes and/or for preventing mood changes. Hence, the necessity exists to verify if, during the last two years, there have been new studies which could fully validate the inclusion of SGAs among the first-line pharmacological options for treating bipolar disorder. Unfortunately, however, the most recent studies were quantitatively and qualitatively inadequate to attenuate doubts about the safe and effective use of SGAs in such patients. For this reason, until now SGAs should be considered as fourth-line agents in all various phases characterizing the fluctuating course of the disorder. Indeed, the use of such medications should be taken into consideration only in the case of failure of therapy with classic mood stabilizing, anticonvulsivant, antidepressant agents, and/or first-generation antipsychotics (FGAs). Nonetheless, if clinicians deem it indispensable to treat these patients with SGA-therapy, olanzapine should still be preferred despite its safety limitations, because the drug continues to show the highest number of well-designed studies with reassuring efficacy findings.

Key words
neuroleptics, atypical/second-generation antipsychotics, risperidone, quetiapine, olanzapine, quetiapine, ziprasidone, aripiprazole, affective/bipolar disorder, mania, depression, effectiveness, safety, efficacy, discontinuation rate


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Especialidades
Principal: Salud Mental
Relacionadas: Bioética, Farmacología, Medicina Farmacéutica



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Enviar correspondencia a:
Salvatore Gentile, Mental Health Center Nº 4 Asl Salerno 1 Department of Mental Health, 84013, Piazza Galdi - Cava de'Tirreni, Salerno, Italia
Patrocinio y reconocimiento:
El Dr. Gentile ha recibido honorarios como conferencista/consultor de Boehringer Ingelheim y Eli Lilly Italia SpA. Durante los últimos cinco años, el también recibió fondos para viajes de Bristol-Myers Squibb, Eli Lilly, Lundbeck y Novartis. No ha recibido apoyo financiero para este estudio.
Bibliografía del artículo

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