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Cilj istraživanja: Cilj ovog istraživanja je utvrditi utjecaj antidepresiva na suicidalnost kod depresivnih pacijenata, njihov protektivni učinak, ali i povećan rizik od suicida. Rad bi mogao doprinijeti u budućem kreiranju smjernica za liječenje depresije i pristupu prema pacijentima sklonim suicidalnim ideacijama. U konačnici, praćenjem sigurnosti antidepresiva i njihovog učinka s obzirom na težinu bolesti i dob, tim pacijentima bi se mogla povećati kvaliteta života i smanjiti broj recidiva. Ispitanici i metode: Prilikom izrade i oblikovanja ovog rada, pretraženi su objavljeni izvorni i pregledni znanstveni radovi. Osnovu rada činile su kliničke studije. Literatura je sustavno pregledana iz područja duševnih poremećaja povezanih sa suicidalnosti. Korišteni su sažetci opisa svojstava i djelovanja lijekova i baza lijekova za tražene terapijske skupine. Bibliografske baze podataka PubMed, Web of Science, Google Scholar, Cochrane pretražene su prema ključnim riječima: major depressive disorder, antidepressants, suicidality, suicidal behaviour, suicidal ideation, young adults, children, side effect, safety, efficacy. Zaključak: Analizom velike količine podataka dolazi se do zaključka da se suicidalne ideacije, događaji i sam čin samoubojstva u rijetkim slučajevima mogu potaknuti liječenjem antidepresivima, primarno inhibitorima ponovne pohrane serotonina. Kliničke karakteristike poput agitacije, ego-distoničnih misli i impulzivnosti možemo smatrati znakovima upozorenja, zbog čega je potrebno navedenim pacijentima posvetiti pozornost, osobito u prva 2 tjedna terapije antidepresivima. Podaci ukazuju na mogućnost prevencije neželjenih suicidalnih događaja kombiniranjem terapije antidepresiva s antipsihoticima na samom početku liječenja. Posebno se intrigantnim čini antisuicidalni učinak ketamina i esketamina u malim dozama. Sve se više dokaza navodi o ulozi opioidnog sustava u suicidalnom ponašanju. Neke studije sugeriraju da suicidalni pacijenti imaju disfunkciju opioidnog sustava, čime se otvaraju potencijalno nove terapijske mogućnosti. Aim of the study: The aim of this study was to determine the impact of antidepressants on suicidality in depressed patients, their protective effect, but also an increased risk of suicide. The paper could contribute to the future development of guidelines for the treatment of depression and the approach to patients prone to suicidal ideation. Ultimately, by monitoring the safety of antidepressants and their effect with respect to disease severity and age, these patients could be able to increase their quality of life and reduce their relapse. Respondents and methods: During the preparation and formation of this paper, published original and reviewed scientific papers were studied. The work was based on clinical studies. The literature has been systematically reviewed in the area of mental disorders associated with suicidality. Summaries of descriptions of drug properties and effects and drug databases for the required therapeutic groups were used. Bibliographic databases PubMed, Web of Science, Google Scholar, Cochrane were searched, and the following keywords were used: major depressive disorder, antidepressants, suicidality, suicidal behavior, suicidal ideation, young adults, children, side effect, safety, efficacy. Conclusion: By analyzing a large amount of data leads to the conclusion that suicidal ideations, events and the act of suicide itself in rare cases can be triggered by treatment with antidepressants, primarily serotonin reuptake inhibitors. Clinical characteristics such as agitation, ego-dystonic thoughts and impulsivity can be considered warning signs, which is why it is necessary to pay attention to these patients, especially in the first 2 weeks of antidepressant therapy. Data suggest the possibility of preventing adverse suicidal events by combining antidepressant therapy with antipsychotics at the outset of treatment. The antisuicidal effect of ketamine and esketamine in small doses seems particularly intriguing. There is growing evidence of the role of the opioid system in suicidal behavior. Some studies suggest suicidal patients have opioid system dysfunction, which potentially opens up new therapeutic possibilities.

Cilj ovog specijalističkog rada je identificirati terapijske probleme s kojima se susreću bolesnici starije životne dobi koji kao terapiju uzimaju opioidne analgetike i antidepresive, pojedinačno ili u kombinaciji. U svrhu istraživanja za potrebe ovog specijalističkog rada napravljen je sustavni pregled relevantnih knjiga i priručnika iz područja medicine i farmakologije, znanstvene i stručne literature kroz bibliografske baze podataka (pubmed i scopus) te mrežnih stranica s bazama lijekova kao što je HALMED. Proučavane su nuspojave i interakcije antidepresiva te opioidnih analgetika kao najčešći terapijski problemi pri primjeni ovih lijekova u starijoj životnoj dobi. Poseban fokus je stavljen na nuspojave i interakcije koje rezultiraju psihičkim tegobama ili bolestima. Najčešća neželjena djelovanja vezana za psihičke tegobe koja se javljaju prilikom primjene opioidnih analgetika su: somnolencija, sedacija, kognitivni poremećaji, vrtoglavica, delirij i psihička ovisnost. Opioidni analgetici stupaju u brojne interakcije. Antikolinergičke, ekstrapiramidalne i psihološke nuspojave antidepresiva uključuju urinarnu retenciju, makularnu degeneraciju, glaukom, poremećaje pamćenja, sedaciju, konfuziju, nesanicu, delirij, pogoršanje psihotičnih poremećaja i demencije, a najčešće se javljaju kod primjene antidepresiva s antikolinergičkim učincima. Interakcije antidepresiva s triptanima, antidepresivima te opioidnim analgeticima može rezultirati serotoninskim sindromom. Od izrazite je važnosti poznavanje pravilne primjene antidepresiva i opioidnih analgetika u osoba starije životne dobi kako bi se izbjegle interakcije koje bi mogle dovesti do pogoršanja stanja bolesnika, ali i fatalnih posljedica. The aim of this paper is to indentify drug related problems encountered by elderly patients who take opioid analgesics and antidepressants as therapy, individually or in combination. For the purpose of researching for this paper, a systematic review was made of relevant books and manuals in the field of medicine and pharmacology, scientific and professional literature through databases (pubmed and scopus) and websites with database such as HALMED. Side effects and interactions of antidepressants and opioid analgesics have been studied as the most common therapeutic problems associated with the use of these drugs in elderly. Particular focus has been placed on side effects and interactions that result in mental disturbances or illness. Most common side effects associated with psychiatric problems that occur when using opioid analgesics are: somnolence, sedation, cognitive disorders, dizziness, delirium, and psychical dependence. Opioid analgesics interact with many drugs. Anticholinergic, extrapyramidal, and psychological side effects of antidepressants include urinary retention, macular degeneration, glaucoma, memory disorders, sedation, confusion, insomnia, delirium, exacerbation of psychotic disorders, and dementia, most commonly occurring with the use of antidepressants with anticholinergic effects. The interaction of antidepressants with tryptans, antidepressants and opioid analgesics can result in serotonin syndrome. It is of utmost importance to know the proper use of antidepressants and opioid analgesics in older people to avoid interactions that could lead to worsening of the condition of the patient and fatal consequences.

Farmakogenetika je znanstvena disciplina koja proučava utjecaja individualnih razlika u slijedu DNA na učinkovitost i toksičnost farmakoterapije. Najčešće ispituje varijante gena koji kodiraju enzime uključene u metabolizam i prijenos lijeka preko različitih membrana. Cilj je rada ukazati na moguću važnost farmakogenetičke analize kao korisnog alata u svakodnevnoj kliničkoj praksi za optimalnu prilagodbu doziranja lijekova čija primjena može rezultirati razvojem serotoninskog sindroma. Ovim su radom prikazani enzimi i transporteri ključni za metaboličke puteve tramadola i čestih konkomitantno primijenjenih antidepresiva. Opisani su mogući patogenetski mehanizmi nastanka serotoninskog sindroma kao posljedica farmakogenetičke predispozicije te interakcija lijekova. Također su opisani i geni koji kodiraju enzime CYP2D6, CYP2C19, CYP3A4, UGT2B7 i transportere P-glikoprotein (Pgp/MDR1/ABCB1) i SERT. Na primjerima opisa slučajeva iz kliničke prakse prikazani su mogući mehanizmi interakcija lijek-lijek-gen. Rezultati analiza upućuju na utjecaj farmakogena u moduliranju interakcija konkomitantno primjenjenog tramadola i antidepresiva, u ovom slučaju escitaloprama, venlafaksina i paroksetina, koje su rezultirale razvojem serotoninskog sindroma. U zaključku treba istaknuti da bi provedba genotipizacije relevantnih gena metaboličkih enzima i transportera važnih u farmakokinetici tramadola i antidepresiva mogla značajno pridonijeti individualiziranom pristupu u primjeni navedenih lijekova te minimalizaciji rizika razvoja štetnih učinaka uključujući serotoninski sindrom. U širem kontekstu ovaj rad ukazuje na potencijal farmakogenetike u personaliziranom pristupu svakom pacijentu radi postizanja željenih terapijskih ishoda, smanjenja nastanka nuspojava, te poboljšanja opće kvalitete zdravstvene skrbi. Pharmacogenetics is a science discipline that studies impacts of interindividual differences in DNA on pharmacotherapy efficacy and toxicity. Most frequently examined are gene variants encoding enzymes responsible for drug metabolism and transmembrane transport. The aim of this paper is to showcase the potential of pharmacogenetic analysis as an useful tool for timely dosing adjustment of medications, containing a high risk of serotonin syndrome development, in every day clinical praxis. This paper takes into account drug metabolizing enzymes and drug transporters of tramadol pathway and concominantly perscribed antidepressants. Showcased are hypothetical pathogenetic mechanisms of serotonin syndrome development as a result of pharmacogenetic predisposition and drug interactions. Genes coding for CYP2D6, CYP2C19, CYP3A4, UGT2B7, MDR1 and SERT are characterized. Clinical case examples were used to describe potential mechnisms of drug-drug-gene interactions. The results of pharmacogenetic analysis confirmed that pharmacogenes have an impact on tramadol-antidepressant polytherapy modulation, in this case escitalopram, vanlafaxine and paroxetine, causing serotonin syndrome development. In conclusion, genotyping genes coding for important metabolic enzymes and transporters of tramadol-antidepressant pharmacokinetics could significantly contribute to individual approach in administration of these drugs and minimize risks of adverse effects incidents, including serotonin syndrome. In a broader context, this paper presents potenitial of pharmacogenetics in personalized approach to every patient in terms of achieving optimal therapy results, avoiding side effects and improving health care quality.

Depresija, bolest kompleksne etiologije i različitih simptoma, danas je globalni zdravstveni problem i najveći uzrok onesposobljenosti u svijetu. Antidepresivi su raznovrsna skupina lijekova pozitivnog učinka na simptome depresije. Klasifikacijske skupine klasičnih antidepresiva su selektivni inhibitori ponovne pohrane serotonina (SIPPS/SSRI), inhibitori ponovne pohrane serotonina i noradrenalina (SNRI), triciklički antidepresivi (TCA), inhibitori monoaminooksidaze (MAOI), selektivni ihibitori ponovne pohrane noradrenalina, inhibitori ponovne pohrane noradrenalina i dopamina, antagonisti 5-HT2/α2 receptora, dualni serotoninski antidepresivi (DSEA), melatoninsko-serotoninski antidepresivi, noradrenergični i specifični serotoninski antidepresivi (NASSA) te multimodalni antidepresivi. Osim ovih dobro poznatih antidepresiva, veliki značaj imaju nove metode liječenja, osobito za pacijente kod kojih se do sada dostupne metode nisu ili su se tek djelomično pokazale korisnima. Suvremene metode liječenja depresije opisane u ovom radu uključuju primjenu ketamina i esketamina, moždanog neurotrofnog čimbenika (BDNF), mikro-RNA (miRNA), serum i glukokortikoid-regulirane-kinaze 1 (SGK1), hormonske terapije te duboke mozgovne stimulacije (DMS/DBS). Većinom su to farmakološke metode u fazi kliničkih istraživanja s pokazanim velikim potencijalom uspješnog liječenja depresije. To potvrđuju dobri rezultati primjene duboke mozgovne stimulacije te bioloških biljega, mikro-RNA i molekule SKG1. Trenutno se najveći uspjeh od do sada odobrenih metoda liječenja očekuje od farmakološkog liječenja esketaminom., Depression, a disease of complex etiology and various symptoms, is nowadays a global health problem and the biggest cause of disability in the world. Antidepressants are a group of diverse medications with a positive effect on depression symptoms. Classification groups of traditional antidepressants are selective serotonin reuptake inhibitors (SSRI), selective norepinephrine and serotonin reuptake inhibitors (SNRI), tricyclic antidepressants (TCA), monoamine oxidase inhibitors (MAOI), selective norepinephrine reuptake inhibitors, norepinephrine and dopamine reuptake inhibitors, 5-HT2α receptor antagonists, dual serotonin antidepressants (DSEA), melatonin-serotonin antidepressants, noradrenergic and specific serotonergic antidepressants (NASSA), and multimodal antidepressants. Beside these well-known antidepressants, new treatment approaches have a great significance, especially for patients with treatment resistant depression. Modern approaches to treating depression described in this paper include usage of ketamine and esketamine, brain derived neurotrophic factor (BDNF), micro-RNA (miRNA), serum and glucocorticoid-regulated kinase 1 (SGK1), hormone therapy and deep brain stimulation (DBS). Most of these are clinical trial phased pharmacological treatments with a great potential of a successful depression treatment based on good results of DBS administration and biological markers micro-RNA and SGK1 administration. The biggest success of so far approved treatments is expected from esketamine usage.

U ovom radu pokušali smo prikazati tijek liječenja bolesnika koji je i u strukturi ličnosti pokazivao znakove i simptome mentalnog funkcioniranja po depresivnom tipu. Prema anamnestičkim i heteroanamnestičkim podacima smatrali smo da će lijek s poticanjem nekoliko transmitorskih sustava biti učinkovitiji u odnosu na težinu kliničke slike, kao i karakteristike strukture ličnosti koju smo pokušali u ovom radu što detaljnije opisati., This paper presents the progress in the treatment of a patient whose personal structure revealed the signs and symptoms of mental functioning in accordance with the depressive personality type. According to anamnestic and heteroanamnestic data, we thought that the medicine would be more effective with stimulation of several transmitter systems with regard to the clinical picture and personality structure characteristics, which have tried to describe in detail in the paper.

Uvod: Depresija je javnozdravstveni psihički poremećaj koji pogađa više od 264 milijuna ljudi u svijetu. Depresivni se poremećaji pojavljuju u bilo kojoj životnoj dobi, vrlo često u osoba mlađe životne dobi i češće ženskog spola. Liječenje se provodi farmakoterapijom, psihoterapijom ili kombinacijom obje, a ponekad i drugim metodama, kao što je elektrokonvulzivna terapija. Usprkos brojnim terapijskim opcijama, u velikog broja oboljelih ne postižu se terapijski ciljevi, a bolest se smatra rezistentnom na terapiju. S obzirom na složenu patofiziologiju bolesti i neizvjesne ishode liječenja, važan je multidiscipliniran pristup i uključenje svih dionika koji skrbe o bolesniku, pri čemu je uloga farmaceuta kao najdostupnijeg zdravstvenog djelatnika od velike važnosti. Cilj istraživanja: Cilj rada je dobiti uvid u indikacije za koje se propisuju antidepresivi, te koji su stavovi pacijenata o propisanoj terapiji. Opservacijsko istraživanje provedeno je na uzorku bolesnika koji podižu svoju terapiju u Ljekarnama PRIMA PHARME. Na osnovu prikupljenih podataka pomoću posebno kreiranog upitnika dobit će se uvid za koje se indikacije propisuju antidepresivi te procijeniti odgovor, uspješnost, adherentnost i zadovoljstvo pacijenata propisanom terapijom. Ispitanici i metode: Opservacijsko istraživanje u ovom radu provedeno je na 22 pacijenta koji su u razdoblju u kojem se istraživanje provodilo (kolovoz – listopad 2020.) podizali svoju terapiju u ljekarni te su pristali sudjelovati u istraživanju. U istraživanju je korišten upitnik kreiran za potrebe rada kojim su se bilježili i ispitivali: medicinska anamneza, propisani lijekovi na recept, bezreceptni pripravci koje pacijent koristi, primijećene nuspojave i zadovoljstvo propisanom terapijom. Od pacijenata je zatražen informirani pristanak za sudjelovanje u istraživanju. Istraživanje je odobreno od Povjerenstva za etičnost eksperimentalnog rada Farmaceutsko – biokemijskog fakulteta Sveučilišta u Zagrebu. Rezultati: Na uzorku od 22 ispitanika njih 69% ima dijagnosticiranu depresiju, dok se kod 31% ispitanika antidepresivi propisuju zbog drugih indikacija. Najčešće propisivani antidepresivi su escitalopram i sertralin, dok je venlafaksin nešto rjeđe propisivan lijek. Osim antidepresiva, ispitanici imaju lijekove za liječenje drugih bolesti. Hipertenzija i hipotireoza su najčešće zabilježene kronične bolesti, dok se gastritis javlja kao posljedica uzimanja veće količine lijekova. Dio pacijenata koristi hipnotike i anksiolitike za primjenu po potrebi, najčešće zbog problema sa spavanjem. Pregledom bezreceptnih pripravaka, manji dio ispitanika koristi dodatke prehrani sa magnezijem i vitaminima B skupine. Odgovori na pitanja koja obuhvaćaju životni stil ispitanika, ukazuju da većina redovito puši cigarete (1 – 2 kutije dnevno), dok se alkohol konzumira prigodno. Nuspojave navodi samo jedan ispitanik, a odnose se na porast apetita. Zaključak: Premda se ovo istraživanje temelji na malom broju pacijenata, rezultati pokazuju da depresija i drugi psihički poremećaji sa sobom nose niz simptoma koje treba liječiti, ali je i praćena različitim komorbiditetima, što traži multidiscipliniran i individualiziran pristup svakom pacijentu. Uloga ljekarnika je od iznimne važnosti kod praćenja ishoda liječenja budući da su ljekarnici zdravstveni djelatnici koji izdaju propisanu terapiju, savjetuju pacijenta, te prate ishode liječenja. Preduvjet za kvalitetnu ljekarničku skrb je stalna edukacija i osobni razvoj, kao i prilagodba pacijentima s kojima smo svakodnevno u kontaktu. Introduction: Depression is a public health mental disorder that affects more than 264 million people worldwide. Depressive disorders occur at any age, very often in people of younger age and more often females. Treatment is carried out with pharmacotherapy, psychotherapy, or a combination of both, and sometimes by other methods, such as electroconvulsive therapy. Despite numerous therapeutic options, a large number of patients do not achive therapeutic goals, and the disease is considered resistant to therapy. Given the complex pathophysiology of the disease and the uncertain outcome of treatment, a multidisciplinary approach and involvement of all stakeholders caring for the patient is important, with the role of the pharmacist as the most accessible health professional being of great importance. Objectives: The aim of this paper is to gain insight into the indications for which antidepressants are prescribed, and what are the attitudes of patients about the prescribed therapy. The observational study was conducted on a sample of patients who raise their therapy in PRIMA PHARMA Pharmacies. Based on the collected data, a specially created questionare will provide insight into the indications for which antidepressants are prescribed and assess the response, success, cooperation and satisfaction of patients with the prescribed therapy. Respondents and methods: Observational research in this study was conducted on 22 patients who in the period in which the study was conducted (August - October 2020) raised their therapy in the pharmacy and agreed to participate in the study. The research used a questionnaire created for the purposes of work that was recorded and examined: medical history, prescribed prescription drugs, over-the-counter preparations used by the patient, observed side effects and satisfaction with the prescribed therapy. Patients were asked for informed consent to participate in the study. The research was approved by Ethics Committee for Experimental Work of the Faculty of Pharmacy and Biochemistry, University of Zagreb. Results: In a sample of 22 subjects, 69% of them were diagnosed with depression, while 31% of subjects were prescribed antidepressants due to other indications. The most commonly prescribed antidepressants are escitalopram and sertraline, while venlafaxine is a somewhat less commonly prescribed drug. In addition to antidepressants, subjects have medications to treat other illnesses. Hypertension and hypothyroidism are the most commonly reported chronic diseases, while gastritis occurs as a result of taking larger amounts of medication. Some patients use hypnotics and anxiolytics for use as needed, most often due to sleep problems. By reviewing over-the-counter preparations, a smaller proportion of respondents use dietary supplements with magnesium and B vitamins. The answers to the questions covering the lifestyle of the respondents indicate that most people smoke cigarettes regularly (1-2 boxes a day), while alcohol is consumed occasionally. Side effects are reported by one respondent and relate to an increase in appetite. Conclusion: Although this research is based on a small number of patients, the results show that depression and other mental disorders carry with them a number of symptoms that need to be treated, but is also accompanied by different comorbidities, which requires a multidisciplinary and individual approach to each patient. The role of the pharmacist is extremely important in monitoring the outcomes of treatment since pharmacists are health professionals who prescribe the prescribed therapy, advise the patient, and monitor the outcomes of treatment. A prerequisite for quality patient care is constant education and personal development, as well as adaptation to patients with whom we are in daily contact

Cilj ovog specijalističkog rada je pregledno prikazati antidepresive i antipsihotike koji mogu utjecati na produljenje QT-intervala koji posljedično može dovesti do iznenadne srčane smrti, te ukazati na važnost uloge farmaceuta u savjetovanju prilikom njihove primjene. Sustavno je pregledana relevantna znanstvena i stručna literatura, te baze lijekova kao što je Hrvatska agencija za lijekove i medicinske proizvode (HALMED) i Europske agencije za lijekove (EMA). Antipsihotici prve generacije imaju višu tendenciju produžavanja QT inetrvala u usporedbi s antipsihoticima druge generacije. Visoki rizik pokazuju tioridazin, pimozid, sulftoprid, droperidol, a u manjoj mjeri i haloperidol i klorpromazin. Atipični antipsihotici koji nose visok rizik od produljenja QT intervala su sertindol i ziprasidon. Risperidon ima nešto niži rizik, a kvetiapin, klozapin i olanzapin imaju zanemariv učinak na QT interval. Triciklički antidepresivi se češće povezuju s produljenjem QT intervala od ostalih skupina antidepresiva. Druga skupina antidepresiva koja može dovesti do produljenja QT intervala su SSRI. Citalopram produljuje QT interval više nego ostali SSRI. Prilikom propisivanja navedenih antipsihotika i antidepresiva moraju se uzeti u obzir i drugi faktori rizika koji mogu dovesti do produljenja QT intervala kao što su ženski spol, starija životna dob, genetika, kardiovaskularni status pacijenata i disbalans elektrolita. Poseban oprez je potreban kada se navedeni antipsihotici i antidepresivi istodobno primjenjuju s lijekovima za koje je poznato da nose rizik od produljenja QT intervala (npr. antiaritmici IA i III skupine, antibiotici, antihistaminici i dr.). Pravilnim savjetovanjem od strane farmaceuta mogao bi se rizik od ove nuspojave značajno smanjiti. The aim of this paper is to present antidepressants and antipsychotics that can affect the prolongation of the QT interval, which can lead to sudden cardiac death, and to point out the importance of the role of pharmacists in counseling when applying this group of drugs. Relevant scientific and professional literature, as well as drug databases such as the Croatian Agency for Medicinal Products and Medical Devices (HALMED) and European Medicines Agency (EMA) have been systematically reviewed. First-generation antipsychotics have a higher tendency to prolong QT intervals compared with second-generation antipsychotics. Thioridazine, pimozide, sulftoprid and droperidol show a high risk, and haloperidol and chlorpromazine show risk to a lesser extent. Atypical antipsychotics that carry a high risk of QT prolongation are sertindole and ziprasidone. Risperidone has a slightly lower risk, and quetiapine, clozapine, and olanzapine have a negligible effect on the QT interval. Tricyclic antidepressants are more commonly associated with QT prolongation than other groups of antidepressants. Another group of antidepressants that can lead to QT prolongation are SSRIs. Citalopram prolongs the QT interval more than other SSRIs. Other risk factors that may lead to QT prolongation, such as female gender, older age, genetics, cardiovascular status of patients, and electrolyte imbalance, must be considered when prescribing these antipsychotics and antidepressants. Special caution is required when these antipsychotics and antidepressants are co-administered with drugs known to carry a risk of QT prolongation (e.g., group IA and III antiarrhythmics, antibiotics, antihistamines, etc.). Proper advice from a pharmacist could significantly reduce the risk of this side effect.

Cilj istraživanja: Cilj ovoga rada je pokazati ima li kvetiapin svoje mjesto u liječenju depresije te prikazati sam problem i težinu depresivnog poremećaja kao bolesti. Rad bi mogao doprinijeti u budućem kreiranju smjernica za liječenje depresije te uključivanju kvetiapina i određivanju njegove uloge u terapijskom postupku, kao i praćenju sigurnosti lijeka, monoterapijski ili u kombinaciji s drugim antidepresivima. Materijal i metode: Pri izradi i oblikovanju ovoga radapretraženi su objavljeni izvorni i pregledni znanstveni radovi. Literatura je sustavno pregledana iz područja mentalnih poremećja i psihofarmakoterapije. Korišteni su sažetci opisa svojstava lijekova, medicinska literatura, pretražene su baze podataka PubMed, Web of Science, Cochrane ključnim riječima: depresija, veliki depresivni poremećaj, atipični atipsihotici, kvetiapin, antidepresivi, usporedba učinka kvetiapina s drugim atipičnim antipsihoticima u velikom depresivnom poremećaju. Za potrebe ovoga rada napravljen je i proveden upitnik na ispitanicima(bolesnicima) u Gradskoj ljekarni Zagreb koji uzimaju lijek kvetiapin za liječenje depresivnog poremećaja. Zaključak: Unatoč tome što je danas depresija jedan od vodećih zdravstvenih problema, oko polovine depresivnih bolesnika ostane i dalje neprepoznato, većina ih se ne liječi, a samo mali broj se liječi prema suvremenim načelima. Za ispravno i upješno liječenje depresije važno je dati ispravnu dijagnozu depresivnog poremećaja u odnosu na intnezitet i prateći komorbiditet. Danas su na tržistu dostupne razne terapijske mogućnosti za liječenje depresivnih stanja od antidepresiva različitih mehanizama djelovanja, augmentativnih terapija kao što su antipsihotici, stabilizatori raspoloženja, neki hormoni, pa do elektrokonvulzivne terapije i psihoterapije. Posebno veliki problem u liječenju depresivnih poremećaja predstavlja veliki depresivni poremećaj. Nerijetko je veliki depresivni poremećaj popraćen psihotičnim obilježjima i anksioznošću ili poremećajem ličnosti kao pratećim psihijatrijskim komorbiditetom, što u znatnoj mjeri ometa svakodnevno psihosocijalno funkcioniranje bolesnika te sama terapija antidepresivima nije više dovoljna za uspješno liječenje. Sve to u konačnici rezultira i slabijom adherencijom od strane bolesnika. Prilikom pregleda literature i provedene ankete,kao vrlo uspješna augmentativna terapija pokazala se terapija atipičnim antipsihoticima, posebno kvetiapinom. Primjena ovoga lijeka dovodi do redukcije anksioznosti ipsihotičnih simptoma te regulacije sna, na što su se bolesnici najčešće tužili. Nadalje, pokazao se učinkovit u smanjenju pojave rezidualnih simptoma i povećanju stope remisijete. Također se pokazalo da je pojavnost neželjenih reakcija dosta niska, naročito kada su u pitanju akutni ekstrapiramidni simptomi koji su nerijetko prateća nuspojava antipsihotika, poglavito prve generacije. Zbog svega toga, augmentacija kvetiapina antidepresivu u kliničkoj praksi se pokazala kao učinkovita i sigurna opcija u liječenju velikog depresivnog poremećaja koja dugoročno vodi funkcionalnom oporavku bolesnika. The aim of this specialistic study is to show whether quetiapine has a place in the treatment of depression and to present the problem and severity of the depressive disorder as a disease. The work could contribute to the future development of guidelines for the treatment of depression, the inclusion of quetiapine and its role in the therapeutic procedure, as well as monitoring the safety of the drug monotherapy or in combination with other antidepressants. Material and Methods: In the design and shaping of this specialistic study, original and review scientific papers have been searched. The literature has been systematically reviewed in the field of mental disorders and psychopharmacotherapy. Abstracts of drug properties were used, medical literature, PubMed, Web of Science, Cochrane databases were searched for keywords: depression, major depressive disorder, atypical atipsychotics, quetiapine, antidepressants, comparison of the effect of quetiapine with other atypical antipsychotics in major depressive disorder. For the purposes of this specialistic study, a questionnaire was developed and administered to subjects (patients) at the Zagreb City Pharmacy who are taking the drug quetiapine for the treatment of depressive disorder. Conclusion: Although depression is one of the leading health problems today, about half of depressed patients remain unrecognized, most are untreated, and only a small number are treated according to modern principles. For the correct and successful treatment of depression it is important to give a correct diagnosis of depressive disorder in relation to the intensity and accompanying comorbidity. Until today, various therapeutic options are available on the market in the treatment of depressive disorders such as antidepressants with different mechanisms of action, augmentation therapies like antipsychotics, mood stabilizers, and some hormones, and finally electroconvulsive therapy and psychotherapy like non-pharmacological methods. A particularly big problem in the treatment of depressive disorders is the major depressive disorder. Often, major depressive disorder is accompanied by psychotic features and anxiety or personality disorder as accompanying psychiatric comorbidity, which significantly impedes the day-to-day psychosocial functioning of the patient, and antidepressant therapy alone is no longer sufficient for successful treatment. All of this ultimately results in less patient adherence. When reviewing the literature and conducting the survey, atypical antipsychotics, especially quetiapine, proved to be a very successful augmentation therapy. Administration of this drug leads to a reduction in anxiety and psychotic symptoms and to the regulation of sleep, which patients have most often complained about. Furthermore, it has been shown to be effective in reducing the onset of residual symptoms and increasing the rate of remission. The incidence of adverse reactions has also been shown to be quite low, especially when it comes to acute extrapyramidal symptoms, which are often an accompanying side effect of antipsychotics, especially the first generation. Due to all this, augmentation of quetiapine antidepressant in clinical practice has proven to be an effective and safe option in the treatment of major depressive disorder, which leads in the long term to the functional recovery of patients.

Bol je iskustvo u koje su uključeni tjelesni, emocionalni i kognitivni procesi. Svaka bol praćena je u određenoj mjeri emocionalnim distresom i strahom, a može biti praćena i poremećenim snom, otežanim kognitivnim funkcioniranjem, anksioznošću, depresivnošću, suicidalnim idejama. Klinička depresija zabilježena je u 50 % pacijenata s kroničnom boli. Kronična bol negativno utječe na osjećaj tjelesnog, emocionalnog i socijalnog blagostanja, kvalitetu života i radnu sposobnost, stvara fi nancijska opterećenja za pojedinca, obitelj, zdravstveni sustav i društvo. Depresija u pacijenata s kroničnom boli negativno doprinosi intenzitetu i trajanju boli, radnom i socijalnom funkcioniranju te ishodima liječenja. S druge strane, zamjetan broj pacijenata s depresijom učestalo se žali na bolne simptome te ti pacijenti pokazuju težu depresiju, slabiji odgovor na liječenje ntidepresivima, teže postizanje remisije, češće rane relapse te nižu razinu svakodnevnog funkcioniranja. U ovom radu prikazane su osnovne spoznaje o biološkoj i psihološkoj prirodi povezanosti boli i depresije te farmakološke i nefarmakološke terapijske mogućnosti., Pain is an experience involving body, emotional and cognitive processes. Every pain is, to a certain extent, accompanied by emotional distress and fear, and may be accompanied by disturbed sleep, impaired cognitive functioning, anxiety, depression, and suicidal ideation. Clinical depression was reported in 50 % of patients with chronic pain, while 25 % of chronic pain patients develop chronic pain syndrome. Chronic pain negatively affects the sense of physical, emotional and social well-being, quality of life and work ability, creates fi nancial burdens for the individual, family, health system and society. In patients with chronic pain, depression has negative effects on pain intensity, duration of pain, occupational and social functioning and the treatment outcomes. A noticeable number of depressed patients often complain of painful symptoms, and these patients show more severe depression, lower rates of response to antidepressants, more diffi culties in achieving remission, more frequent early relapses and a lower levels of everydaily functioning. This paper presents basic knowledge of the biological and psychological nature of pain and depression and therapy possibilities, pharmacological and nonpharmacological.