Folna kiselina u terapiji depresivnog poremećaja

Abstract

Cilj ovog istraživanja je bio da se utvrdi nivo folne kiseline u serumu (fiziološka vrednost je od 16,31 do 34,88 nmol/l) i proceni težina kliničke slike instrumentima kliničke procene (HAMD 17 i 21, MADRS i CGI skala) u populaciji bolnički lečenih pacijenata, koji boluju od teške depresivne epizode, ili rekurententog depresivnog poremećaja, i njihov odgovor na inicijalnu antidepresivnu terapiju sprovođenu prema smernicama nacionalnog vodiča. Odgovor na antidepresivnu terapiju je određivan nakon četiri i osam nedelja lečenja u odnosu na nivo folne kiseline i prema nadoknadi folne kiseline u dozi od 15 mg dnevno (kod pacijenata koji nisu adekvatno odreagovali na terapiju). Smatrano je da je antidepresivni odgovor adekvatan ukoliko je utvrđena redukcija skora na HAMD (17, 21) i MADRS za 50%. Istraživanje je obuhvatilo 102 pacijenata (69 osoba ženskog pola i 33 osobe muškog pola) starosti između 18 i 70 godina života. Utvrđeno je da je snižen nivo folne kiseline u krvi imalo 41,2% pacijenata. X2 testom je ustanovljeno da postoje značajne razlike nivoa folne kiseline u krvi u odnosu na pol. Snižen nivo folne kiseline je zastupljeniji kod osoba muškog pola. Pacijenati sa sniženim nivoom folne kiseline su imali inicijalno značajno više skorove na skalama kliničke procene i izostanak adekvatnog terapijskog odgovora u četvrtoj nedelji lečenja. U osmoj nedelji lečenja se ta razlika u terapijskom odgovoru izgubila. Utvrđena je statistički značajna razlika u skorovima na HAMD (17) i MADRS u tri merenja u zavisnosti od nivoa folne kiseline i nadoknade uz upotrebu višesmerne mešovite analize varijanse (ANOVA). Utvrđeno je da postoji značajan glavni efekat merenja (skorovi se značajno razlikuju od merenja do merenja), i značajan efekat interakcije merenja i nadoknade.

The aim of this paper is to establish the levels of folic acid in serum (physiological values is from 16.31 to 34.88 nmol/l) and the assessment of seriousness of clinical picture by clinical assessment instruments (HAMD 17 and 21, MADRS and CGI scales) in the population of hospitalized patients suffering from severe depressive episodes, or recurrent depressive disorder, and their response to the initial anti-depressant therapy administered according to national guidelines. The response to anti-depressant therapy was determined after four or eight weeks of treatment in relation to the levels of folic acid and according to recuperation of folic acid in the dose of 15 mg daily (in patients who did not react adequately to the therapy). It was believed that the anti-depressive response was satisfying in case of the established score reduction on HAMD (17, 21) and MADRS for 50%. The research encircled 102 patients (69 of whom female patients and 33 males) aged between 18 and 70. A reduced level of folic acid in blood was found in 41.2% of the patients. By X2 test determined that there were significant differences in the levels of folic acid in relation to the patient gender. A reduced level was more found in male patients. The patients with reduced levels of folic acid had initially significantly higher scores on clinical assessment scales and the lack of an adequate therapeutic response in the fourth week of the treatment. In the eighth week of the treatment that difference vanished in therapeutic response. A statistically significant difference was determined on HAMD (17) and MADRS during three measurements depending on the levels of folic acid and its recuperation by using a multiway diverse analysis of variance (ANOVA). It was determined that there is a significant central effect of measurements (scores significantly differ from measurement to measurement), as well as an effect of interaction of measurements and the recuperation.