| Abstract | Depresija je vrlo čest mentalni poremećaj koji pogađa čitavu svjetsku populaciju, javlja se u
približno 5-6% odraslih osoba, a zabrinjavajuća činjenica jest da se javlja i u 2% dječje populacije
te 4-8% adolescenata. Cilj ovog diplomskog rada jest ukazati na ozbiljan društveni problem te na
važnost ranog kognitivno-bihevioralnog psihoterapijskog i farmakoterapijskog pristupa oboljelima.
Prilikom dijagnosticiranja depresije važno je razlikovati kliničko depresivno stanje od normalne
tuge i promjena raspoloženja. Nastanak i razvoj depresije nastoji se objasniti različitim biološkim
hipotezama, kao što su genska predispozicija, smanjena količina ili funkcija monoamina u
središnjem živčanom sustavu, smanjene razine glutamata i neurotrofnog čimbenika moždanog
podrijetla, stanje upale, hormonalni poremećaji, dok s druge strane postoje razne psihosocijalne
teorije poput psihodinamske, bihevioralne, kognitivne te humanističkog pristupa razvoju depresije.
Početno liječenje depresije, posebice blažeg oblika, u djece i adolescenata čini psihoedukacija uz
praćenje stanja pacijenta 6-8 tjedana prije samog liječenja antidepresivima ili psihoterapije. U
slučaju blage depresije, aktivna podrška i praćenje obiteljskih liječnika pokazala se kao važna
terapijska strategija, a između ostalog uključuje zakazivanje čestih kontrolnih posjeta. U slučaju
umjerene do teške depresije, uvodi se farmakoterapija i/ili psihoterapija. Prvu liniju antidepresiva
za primjenu kod djece i adolescenata predstavljaju selektivni inhibitori ponovne pohrane
serotonina, odnosno fluoksetin koji je jedini odobren od strane regulatornih agencija za lijekove,
dok je escitalopram odobren za primjenu u pedijatrijskoj populaciji starijoj od 12 godina.
Farmakokinetika lijekova zbog fizioloških posebnosti u dječjoj dobi je drugačija, što
podrazumijeva prilagodbu doze i intervala doziranja. Liječenje antidepresivima treba nastaviti i
nakon povlačenja simptoma u razdoblju od 6 do 12 mjeseci. Elektrokonvulzivna terapija
primjenjuje se kod teškog oblika depresije sa ili bez psihotičnih simptoma, i to nakon slabog ili
nikakvog odgovora na farmakoterapiju u kombinaciji sa psihoterapijom.
Depresija, čija prevalencija u dječjoj i adolescentskoj dobi kontinuirano raste, predstavlja sve veći
problem, kako oboljelima i njihovim skrbnicima, tako i svim dionicima uključenima u odgoj i
pružanje skrbi toj najosjetljivijom populaciji. Poseban izazov predstavlja terapija, gdje nedostaje
jasnih smjernica, što ukazuje na nužnost dobro dizajniranih kliničkih studija kako bi se osigurala
dugoročno učinnkoviti i sigurni terapijski pristupi temeljeni na dokazima. |
| Abstract (english) | Depression is a very common mental disorder that affects the entire world population, it occurs in
approximately 5-6% of the adults, and the worrying fact is that it also occurs in 2% of the
children's population and 4-8% of the younger population. The aim of this thesis is to point out a
serious social problem and the importance of an early cognitive-behavioral psychotherapeutic and
pharmacotherapeutic approach. When diagnosing depression, it is important to distinguish a
clinically clear depressive state from normal sadness, and criteria for a depressive episode include
depressed mood, loss of interest and pleasure for at least 2 weeks, and changes from previous
functioning. The origin and development of depression is trying to be explained by different
biological hypotheses, such as genetic predisposition, reduced amount or function of monoamines,
reduced level of glutamate and brain-derived-neurotrophic factor, inflammatory state, hormonal
disorders, while on the other hand there are various psychosocial theories such as psychodynamic,
behavioral, cognitive and humanistic approach to the development of depression. The initial
treatment of depression among children and adolescents consists of psychoeducation, and it is
necessary to monitor the patient's condition for 6-8 weeks using validated scales before treatment
with antidepressants or psychotherapy. In the case of mild depression, active support and
monitoring by family doctors has proven to be an important therapeutic strategy, and among other
things, it includes scheduling frequent control visits. In the case of moderate to severe depression,
family doctors should consult with mental health services and then begin with antidepressant
therapy or psychotherapy. The first line of antidepressants for children and adolescents are
selective serotonin reuptake inhibitors, while tricyclic antidepressants should be removed from
therapy because they do not show sufficient effectiveness, and in addition, they cause serious sideeffects
that are fatal in case of overdose. Fluoxetine is the best choice for the treatment of
depression among children and adolescents because it is the only one approved by the FDA for this
use, while escitalopram is approved for use in the pediatric population older than 12 years. The
metabolism of drugs in children and adolescents differs from that in adults, it is increased in
children and adolescents, therefore withdrawal symptoms may occur and for this reason the dosage
should be adjusted. Treatment with antidepressants should be continued even after the withdrawal
of symptoms for a period of 6 to 12 months. The therapy should not be stopped suddenly, the dose
should be gradually reduced, otherwise a withdrawal syndrome could occur. Electroconvulsive
therapy is used in severe depression with or without psychotic symptoms, i.e. after a weak or no
response to pharmacotherapy in combination with psychotherapy.Depression, whose prevalence in
children and adolescents is continuously increasing, is a growing problem, both for sufferers and
their caregivers, as well as for all stakeholders involved in the education and provision of care to
this most sensitive population. A particular challenge is therapy, where there is a lack of clear
guidelines, which indicates the necessity of well-designed clinical studies to ensure long-term
effective and safe evidence-based therapeutic approaches. |
