Depressão: nova droga de ação rápida poderá ajudar milhões de pessoas

depressão

Depressão: Um dos maiores desafios da psiquiatria é ajudar milhões de pessoas com depressão que não se beneficiam de nenhum tratamento atualmente disponível, seja medicamento ou psicoterapia.

Agora, uma nova terapia – uma droga de ação rápida derivada de um anestésico antigo e amplamente usado, a cetamina – foi aprovada pela Administração de Drogas e Alimentos dos EUA e pode representar uma esperança para esses pacientes.

O tratamento, chamado de esketamina (ou esletamina), é um spray nasal desenvolvido pela Janssen Pharmaceuticals Inc., uma filial da Johnson & Johnson, e será comercializado sob o nome de Spravato.

Ele contém uma porção ativa da molécula de cetamina, cujas propriedades antidepressivas ainda não são bem compreendidas. Apesar disso, o anestésico genérico está cada vez mais disponível em centenas de clínicas em todo os EUA, que fornecem um curso de tratamentos intravenosos para depressão.

Uma vez que a esketamina foi aprovada oficialmente pelo governo americano – diferentemente desses tratamentos intravenosos -, o custo de tal medicação provavelmente será mais acessível e coberto por muitos planos de seguro.

Além disso, seus efeitos colaterais, embora semelhantes aos da cetamina genérica, são considerados menos dramáticos.

O tratamento

O uso recomendado do medicamento recém-aprovado é duas vezes por semana durante quatro semanas, com reforços conforme necessário, juntamente com um antidepressivo oral comumente usado.

A aprovação americana exige que as doses sejam administradas em um consultório médico, com pacientes monitorados por pelo menos duas horas. Sua experiência deve ser registrada, e os indivíduos não devem dirigir no dia do tratamento.

Esse monitoramento de segurança é necessário porque a esketamina, como a cetamina, pode criar dependência. A cetamina muitas vezes causa sensações alucinógenas quando administrada; nos anos 1980 e 90, era popular como droga de entretenimento em boates. Ambas as substâncias têm a capacidade de induzir episódios psicóticos em pessoas com alto risco para a condição.

Segundo a Janssen, o custo de um mês de tratamento será de cerca de US$ 4.720 a US$ 6.785 (R$ 18.120 a R$ 26.050).

Ação rápida

A aprovação da esketamina marca uma nova abordagem para tratar problemas graves de humor.

Prozac e drogas similares aumentam a atividade de mensageiros cerebrais, como a serotonina; são levemente eficazes, mas demoram semanas ou meses para que seus efeitos sejam sentidos e, para muitos pacientes, proporcionam pouco ou nenhum alívio da depressão.

Em contraste, os compostos à base de cetamina – vários outros estão sendo desenvolvidos – funcionam em questão de horas ou dias e são eficazes em algumas pessoas que são consideradas “resistentes ao tratamento”, o que significa que não se beneficiaram de outros antidepressivos.

Especialistas com longa experiência no tratamento da depressão consideram essa aprovação promissora, mas também pedem cautela. A eficácia da classe anterior de antidepressivos, como Prozac e Paxil, foi muito exagerada quando chegou ao mercado, por exemplo. E os resultados dos testes com a esketamina também demonstram problemas.

Experimentos

Em cada teste feito pela Janssen, todos os pacientes receberam um novo medicamento antidepressivo e um tratamento de esketamina ou um placebo.

Em um estudo de um mês, os do grupo da esketamina tiveram um desempenho estatisticamente melhor do que aqueles que receberam placebo. Em dois outros experimentos, a droga não superou estatisticamente o tratamento com placebo.

Historicamente, a Administração de Drogas e Alimentos americana exige que um medicamento tenha sucesso em dois testes de curto prazo antes de ser aprovado; a agência afrouxou seus critérios para a esketamina, porém, graças a um outro estudo sobre recaída em pessoas que se saíram bem com a droga.

Nesse experimento, a Janssen informou que apenas cerca de um quarto dos indivíduos recaíram, em comparação com 45% dos indivíduos que receberam o spray placebo. Todos os indivíduos desse teste tinham recebido um diagnóstico de depressão resistente ao tratamento, tendo anteriormente falhado em múltiplos ciclos de terapia com outras drogas.

Esketamina: um novo caminho

A cetamina foi desenvolvida há mais de cinco décadas como uma alternativa mais segura ao anestésico fenciclidina e é usada em todo o mundo, em salas de cirurgia, no campo de batalha e em clínicas pediátricas. A Organização Mundial de Saúde (OMS) listou a substância como um dos seus medicamentos essenciais desde 1985.

Foi na década de 1990 que o interesse se voltou para o potencial da droga para combater a depressão. Em 2000, uma equipe de pesquisadores da Universidade de Yale e do Centro de Saúde Mental de Connecticut, liderados pelo Dr. Robert M. Berman, relatou que doses de cetamina proporcionaram alívio rápido a sete pessoas com depressão.

O campo decolou em 2006, quando uma equipe do Instituto Nacional de Saúde Mental, liderada pelo Dr. Carlos Zarate Jr., relatou que 18 pessoas resistentes ao tratamento que receberam a droga por via intravenosa relataram que seu desespero se dissipou em questão de horas.

A capacidade aparente da cetamina de neutralizar o pensamento suicida é particularmente convincente, e a Janssen está buscando essa mesma indicação para a esketamina.

“Não tivemos nada de novo em 30 anos”, disse Steven Hollon, professor de psiquiatria e ciência do comportamento da Universidade Vanderbilt. “Então, se esta droga é uma maneira eficaz de obter uma resposta mais rápida em pessoas que são resistentes ao tratamento, e podemos usá-la com segurança, pode ser uma dádiva”. [NYTimes]

 

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ด้วยทัศนียภาพสุดงามตลอดทางจนถึงจุดยอด ถ้าคุณคิดจะไป อย่าลืมฟิตร่างกายให้พร้อมด้วยล่ะ

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(วัดภูทอก) จ.บึงกาฬ
สถานที่ท่องเที่ยวพิสูจน์หัวใจอีกแห่งหนึ่ง แม้ระยะทางจะไม่ไกลและไม่สูงมากนัก แต่การที่คุณจะขึ้นไปจุดสูงสุดของวัดภูทอกแห่งนี้ ที่เรียกว่า “พุทธวิหาร” คุณจะต้องเดินขึ้นบันไดและสะพานไม้สุดคดเคี้ยวและหวาดเสียว ฝ่าลมแรงขึ้นไปพบกับจุดชมวิวสุดลูกหูลูกตา ขอบอกเลยว่าไม่ง่าย แต่ก็ไม่ยากเกินแรงศรัทธาของทุกคน

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เขื่อนรัชชประภา
หรือเขื่อนเชี่ยวหลาน แห่งนี้ ได้รับฉายาว่า “มัลดีฟส์เมืองไทย” จากทิวทัศน์รีสอร์ทบ้านไม้ริมน้ำที่เรียงรายกัน ประกอบกับกระแสน้ำที่นิ่งสงบ มีพื้นหลังเป็นภูเขาและท้องฟ้าสดใส พร้อมกิจกรรมพายเรือแคนู ที่จะทำให้คุณเพลิดเพลินจนลืมเวลาไปเลยล่ะ
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และสัตว์ป่าหลากชนิด คุณจะได้พบกับเลียงผา กวางผา และนกพันธุ์หายาก พอคุณขึ้นไปถึงยอดดอย คุณอาจตกใจว่านี่คุณตายแล้วใช่มั้ย ถึงได้มาอยู่บนสวรรค์ มันจะสวยงามขนาดนั้นเชียวหรือ ?

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ที่ใน 1 ปี จะเปิดให้นักท่องเที่ยวขึ้นไปสัมผัสธรรมชาติแค่ 3 เดือนเท่านั้น เพื่อรักษาระบบนิเวศน์ ตลอดเส้นทางคุณจะพบกับป่าโปร่งสลับกับทุ่งหญ้า จุดไฮไลท์อยู่ที่ “สันคมมีด” สันเขาที่สวยงามและน่าหวาดเสียว เมื่อขึ้นไปถึงยอดเขาจะสามารถมองเห็นวิวได้รอบทิศทาง 360 องศา

9. วัดเฉลิมพระเกียรติพระจอมเกล้าราชานุสรณ์ จังหวัดลำปาง
แหล่งท่องเที่ยวสุดลับฉบับลำปาง
กับจุดชมทิวทัศน์แบบพาโนรามา 360 องศา ที่จะทำให้คุณได้ยลโฉมวิวสุดอลังการของอำเภอต่างๆ โดยมี
“ดอยปู่ยักษ์” ตั้งตระหง่านอยู่ ยอดเขามีลักษณะเป็นผาหินสูงชัน บนยอดที่สูงที่สุดนั้น มีรอยพระพุทธบาทศักดิ์สิทธิ์ประดิษฐานอยู่ การจะขึ้นไปนั้นต้องอาศัยศรัทธาอย่างแรงกล้า

10. เกาะตาชัย จังหวัดพังงา
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ด้วยหาดทรายขาวเม็ดละเอียด ยาวทอดตัวขนานกับผืนทะเลประมาณ
700 เมตร และการเดินท่องป่า สัมผัสชีวิตปูไก่ ที่สำคัญยังเป็นจุดดำน้ำดูปะการัง ที่สวยงามที่สุดอีกแห่งหนึ่งของเมืองไทยอีกด้วย

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