Hipomanija indukovana primenom repetitivne transkranijalne magnetne stimulacije i parcijalne deprivacije spavanja kod bolesnika na terapiji antidepresivima

  • Jelena Krstić Psychiatric Hospital, Clinical Hospital Center “Dr Dragiša Mišović”-Dedinje, Belgrade, Serbia; Faculty of Biology, University of Belgrade, Belgrade, Serbia;
  • Tihomir V. Ilić Department of Clinical Neurophysiology, Clinic of Neurology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine, Military Medical Academy, University of Defence, Belgrade, Serbia
DOI: https://doi.org/10.2298/2217
Ključne reči: bipolar disorder||, ||psihoze, manično-depresione, diagnosis, differential||, ||dijagnoza, diferencijalna, depression||, ||depresioni poremećaji, antidepressive agents||, ||antidepresivi, sleep deprivation||, ||, transcranial magnetic stimulation||,

Sažetak


Uvod. Bipolarna depresija često se ne prepoznaje, a teškoće u njenom lečenju odnose se na dva suprotna problema: terapijsku rezistenciju i rizik od maničnog preokreta. Prikaz bolesnika. Bolesnica stara 53 godine, lečena je od unipolarnog depresivnog poremećaja od svoje 36. godine. Tokom nedavne epizode velike depresije tokom sedam meseci dominirala su stalna osećanja potišenosti, gubitak interesovanja za uobičajene aktivnosti, teška nesanica i izrazita somatska anksioznost. Posle dva neuspela terapijska pokušaja sa različitim antidepresivima primenjenim u odgovarajućim dozama i dovoljno dugo, započeta je terapija niskofrekventnom repetitivnom transkranijalnom magnetnom stimulacijom (rTMS). Tokom rTMS terapije bolesnica je nastavila da prima nepromenjenu dozu antidepresiva. Parcijalna deprivacija spavanja (PSD) dodatno je primenjena u dva navrata tokom ove dve nedelje sa idejom da će potencirati ili pospešiti terapijski odgovor. Tokom poslednje dve rTMS sesije, simptomi depresije bili su značajno smanjeni, ali je bolesnica ispoljavala i simptome hipomanije. Terapija rTMS je prekinuta i hipomanični simptomi su postepeno prestali. U roku od dve nedelje posle rTMS terapije bolesnica je bila eutimična. Terapija antidepersivom je nastavljena. U periodu praćenja u naredne dve godine definitivno je postavljena dijagnoza bipolarnog afektivnog poremećaja. Zaključak. U ovom prikazu bolesnice, pokazalo se da istovremena primena rTMS i deprivacije spavanja kod bolesnika sa nepromenjenom dozom antidepresiva ima snažan sinergistički efekat, čak sa mogućnošću da izazove manični preokret, što je ujedno, prema našim saznanjima, prvi do sada objavljeni slučaj hipomanije indukovane ovom kombinacijom antidepresivnih terapija.

Reference

Bond DJ, Noronha MM, Kauer-Sant'Anna M, Lam RW, Yatham LN. Antidepressant-associated mood elevations in bipolar II disorder compared with bipolar I disorder and major depres-sive disorder: a systematic review and meta-analysis. J Clin Psychiatry 2008; 69(10): 1589−601.

Akiskal HS, Hantouche EG, Allilaire JF, Sechter D, Bourgeois ML, Azorin JM, et al. Validating antidepressant-associated hypoma-nia (bipolar III): a systematic comparison with spontaneous hypomania (bipolar II). J Affect Disord 2003; 73(1−2): 65−74.

Padberg F, George MS. Repetitive transcranial magnetic stimula-tion of the prefrontal cortex in depression. Exp Neurol 2009; 219(1): 2−13.

Fitzgerald PB, Huntsman S, Gunewardene R, Kulkarni J, Daskalakis ZJ. A randomized trial of low-frequency right-prefrontal-cortex transcranial magnetic stimulation as augmentation in treatment-resistant major depression. Int J Neuropsychophar-macol 2006; 9(6): 655−66.

Krstic J, Diligenski V, Ilic TV. Low-frequency repetitive tran-scranial magnetic stimulation conjugated with partial sleep de-privation in treatment of major depression-pilot study. Clin Neurophysiology 2010; 121(4): e9−e10.

Colombo C Benedetti F, Barbini B, Campori E, Smeraldi E. Rate of switch from depression into mania after therapeutic sleep de-privation in bipolar depression. Psychiatry Res 1999; 86(3): 267−70.

Xia G, Gajwani P, Muzina DJ, Kemp DE, Gao K, Ganocy SJ, et al. Treatment emergent mania in unipolar and bipolar depression: focus on repetitive transcranial magnetic stimulation. Int J Neuropsychopharmacol 2008; 11(1): 119−30.

Wu JC, Gillin JC, Buchsbaum MS, Schachat C, Darnall LA, Keator DB, et al. Sleep deprivation PET correlations of Hamilton symptom improvement ratings with changes in relative glucose metabolism in patients with depression. J Affect Disord 2008; 107(1−3): 181−6.

Smith DF, Jakobsen S. Molecular tools for assessing human de-pression by positron emission tomography. Eur Neuropsy-chopharmacol 2009; 19(9): 611−28.

Kimbrell TA, Dunn RT, George MS, Danielson AL, Willis MW, Repella JD, et al. Left prefrontal-repetitive transcranial magnetic stimulation (rTMS) and regional cerebral glucose metabolism in normal volunteers. Psychiatry Res 2002; 115(3): 101−13.

American Psychiatric Association. Diagnostic and statistic manuel of mental disorders. 4th ed. Text revision. Washington, DC: American Psychiatric Association; 2000.

Pascual-Leone A, Rubio B, Pallardo F, Catala MD. Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression. Lancet 1996; 348(9022): 233−7.

Giedke H, Schwarzler F. Therapeutic response of sleep depriva-tion in depression. Sleep Med Rew 2002; 6(5): 361−77.

Rachid F, Bertschy G. Safety and efficacy of repetitive transcranial magnetic stimulation in the treatment of depression: a critical appraisalof the last 10 years. Neurophysiol Clinique 2006; 36(3):157−83.

Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry 2003; 64(2): 161−74.

Nedjat S, Folkerts HW. Induction of a reversible state of hypo-mania by rapid-rate transcranial magnetic stimulation over the left prefrontal lobe. J ECT 1999; 15(2): 166−8.

Ella R, Zwanzger P, Stampfer R, Preuss UW, Muller-Siecheneder F, Moller HJ, et al. Switch to mania after slow rTMS of the right prefrontal cortex. J Clin Psychiatry 2002; 63(3): 249.

Hausmann A, Kramer-Reinstadler K, Lechner-Schoner T, Walpoth M, Rupp CI, Hinterhuber H, et al. Can bilateral prefrontal repetitive transcranial magnetic stimulation (rTMS) induce mania? A case report. J Clin Psychiatry 2004; 65(11): 1575−6.

Fitzgerald PB, Brown TL, Marston NA, Daskalakis ZJ, De CA, Kulkarni J. Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Arch Gen Psychiatry 2003; 60(10): 1002−8.

Sakkas P, Mihalopoulou P, Mourtzouhou P, Psarros C, Masdrakis V, Politis A, et al. Induction of mania by rTMS: report of two cas-es. Eur Psychiatry 2003; 18(4): 196−8.

Objavljeno
2015/04/21
Broj časopisa
Vol. 71 Br. 2 (2014)
Rubrika
Prikaz bolesnika