Vol. 13. Núm. 84.
Páginas 4970-4977 (Septiembre 2023)

Protocolos de práctica asistencial
Protocolo terapéutico de los trastornos del humor

Therapeutic protocol for mood disorders

Í. Alberdi PáramoaM. Pérez LombardoaM.Á. Álvarez-MonbR. Molina-Ruiza
Doi : https://10.1016/j.med.2023.08.006
Opciones
Resumen

El tratamiento de los trastornos del humor incluye el uso de antidepresivos y de estabilizadores del humor en el trastorno bipolar y, en algunos casos, de depresión resistente. El tratamiento debe ser acorde con la gravedad, personalizado para cada caso, integrador y basado en la evidencia científica. Las medidas terapéuticas incluyen también pautas higiénico-dietéticas, ejercicio físico, psicoterapia, rehabilitación funcional y, en ocasiones, terapia electroconvulsiva. Este protocolo incluye algoritmos, tablas y figuras con el objetivo de facilitar la decisión del tratamiento farmacológico a emplear.

Palabras clave
Depresión
Trastorno bipolar
Antidepresivos
Eutimizantes
Abstract

The treatment of mood disorders includes the use of antidepressants and mood stabilizers in bipolar disorder and, in some cases, treatment-resistant depression. Treatment must be in accordance with severity, personalized for each case, comprehensive, and based on scientific evidence. Therapeutic measures also include hygiene and dietary measures, physical exercise, psychotherapy, functional rehabilitation, and, on occasion, electroconvulsive therapy. This protocol includes algorithms, tables, and figures with the aim of facilitating the decision on which pharmacological treatment to use.

Keywords
Depression
Bipolar disorder
Antidepressants
Mood stabilizers

Identifíquese

¿Aún no es suscriptor de la revista?

Comprar el acceso al artículo

Comprando el artículo el pdf del mismo podrá ser descargado

Teléfono para incidencias

De lunes a viernes de 9h a 18h (GMT+1) excepto los meses de julio y agosto que será de 9 a 15h

Llamadas desde España 932 415 960
Llamadas desde fuera de España +34 932 415 960
Bibliografía
[1]
V. Pereira Sánchez
202308310626069368
, P. Molero Santos.
Protocolo diagnóstico y terapéutico de la depresión.
Medicine., (2019), 12 pp. 5070-5074
[2]
Manual de depresión, Grupo Aula Médica,
[3]
C. Otte
2023083106260693611
, S.M. Gold, B.W. Penninx, C.M. Pariante, A. Etkin, M. Fava, et al.
Major depressive disorder.
Nat Rev Dis Primers., (2016), 2 pp. 16065
[4]
R.S. McIntyre
2023083106260693612
2023083106260693613
, M. Berk, E. Brietzke, B.I. Goldstein, C. López-Jaramillo, L.V. Kessing, et al.
Bipolar disorders.
Lancet., (2020), 396 pp. 1841-1856
[5]
M. Arrieta
2023083106260693614
, P. Molero Santos.
Protocolo diagnóstico y terapéutico del paciente con trastorno bipolar.
Medicine (Baltimore)., (2019), 12 pp. 5081-5087
[6]
D.M. Taylor
2023083106260693615
2023083106260693616
, T.R. Barnes, A.H. Young.
The Maudsley. Prescribing guidelines in Psychiatry.
14a ed, Wiley-Blackwell, (2021),
[7]
G. Gartlehner
2023083106260693617
, K. Thaler, S. Hill, R.A. Hansen.
How should primary care doctors select which antidepressants to administer?.
Curr Psychiatry Rep., (2012), 14 pp. 360-369
[8]
G.S. Malhi
2023083106260693618
, J.J. Mann.
Depression.
Lancet, (2018), 392 pp. 2299-2312
[9]
A. Cipriani
2023083106260693619
2023083106260693620
, T.A. Furukawa, G. Salanti, A. Chaimani, L.Z. Atkinson, Y. Ogawa, et al.
Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis.
Lancet., (2018), 391 pp. 1357-1366
[10]
S.M. Stahl
2023083106260693621
.
Guía del prescriptor.
Antidepresivos., (2017),
[11]
B. Sadock
2023083106260693622
, V. Sadock, P. Ruiz.
Sinopsis de Psiquiatría.
Ciencias del comportamiento/Psiquiatría clínica, Wolters Kluwer,
[12]
S.M. Stahl
2023083106260693623
.
Stahĺs essential psychopharmacology.
6ª ed, Prescribeŕs Guide, (2017),
[13]
C. Álamo
2023083106260693624
, F. López-Muñoz.
Fármacos antidepresivos.
Terapéutica farmacológica de los trastornos del sistema nervioso Programa de Actualización en Farmacología y Farmacoterapia, Consejo General de Colegios Oficiales de Farmacéuticos, (2012),
[14]
Alberdi-Páramo
2023083106260693625
Í, Barbudo del Cura E. Psicofármacos 2. En: Manual de Psiquiatría. 2a ed. Amir Salud, S.L.; 2021.
[15]
NICE
2023083106260693626
2023083106260693627
.
National Institute for Health and Care Excellence. Overview | Depression in adults: recognition and management | Guidance | NICE. NICE Guidance.
NICE, (2018),
[16]
Thase
2023083106260693628
2023083106260693629
M, Connolly R. Unipolar depression in adults: Choosing treatment for resistant depression. UpToDate 2020. Disponible en: www.update.com.
[17]
K.R. Connolly
2023083106260693630
, M.E. Thase.
If at first you don’t succeed: a review of the evidence for antidepressant augmentation, combination and switching strategies.
[18]
S.H. Kennedy
2023083106260693631
, R.W. Lam, R.S. McIntyre, S.V. Tourjman, V. Bhat, P. Blier, et al.
CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical guidelines for the management of adults with major depressive disorder: Section 3. Pharmacological Treatments.
Can J Psychiatry., (2016), 61 pp. 540-560
[19]
V. Pérez Sola
2023083106260693632
2023083106260693633
, D. Puigdemont, L. Mora, P. Álvarez, F.J. De Diego.
Depresión mayor unipolar y resistencia al tratamiento.
In: Depresiones Bipolares y Unipolares Qué hacer en los pacientes que no responden suficientemente a los tratamientos habituales, Editorial Médica Panamericana;, (2019), pp. 13-32
[20]
E. Vieta
2023083106260693634
, F. Colom.
Therapeutic options in treatment-resistant depression.
Ann Med [Internet]., (2011), 43 pp. 512-530
[21]
R. Strawbridge
2023083106260693635
, B. Carter, L. Marwood, B. Bandelow, D. Tsapekos, V.L. Nikolova, et al.
Augmentation therapies for treatment-resistant depression: systematic review and meta-analysis.
Br J Psychiatry., (2019), 214 pp. 42-51
[22]
A. Cleare
2023083106260693636
, C.M. Pariante, A.H. Young, I.M. Anderson, D. Christmas, P.J. Cowen, et al.
Members of the Consensus Meeting. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines.
J Psychopharmacol., (2015), 29 pp. 459-525
[23]
American
2023083106260693637
Psychiatric Association.
American Psychiatric Association: Practice Guideline for the Treatment of Patients with Major Depressive Disorder.
3rd ed., (2010),
[24]
J. Spijker
2023083106260693638
, W. Nolen.
An algorithm for the pharmacological treatment of depression.
Acta Psychiatr Scand., (2010), 121 pp. 180
[25]
N. Cardoner Álvarez
2023083106260693639
.
Abordaje farmacológico y terapias físicas.
En: Pautas de actuación y seguimiento. Depresión, (2023), pp. 53-74
[26]
V. Kini
2023083106260693640
2023083106260693641
, P.M. Ho.
Interventions to improve medication adherence: A review.
JAMA., (2018), 320 pp. 2461-2473
[27]
S.R. Wisniewski
2023083106260693642
, M. Fava, M.H. Trivedi, M.E. Thase, D. Warden, G. Niederehe, et al.
Acceptability of second-step treatments to depressed outpatients: A STAR*D report.
Am J Psychiatry., (2007), 164 pp. 753-760
[28]
R.M.A. Hirschfeld
2023083106260693643
, S.A. Montgomery, E. Aguglia, M. Amore, P.L. Delgado, M. Gastpar, et al.
Partial response and nonresponse to antidepressant therapy: Current approaches and treatment options.
J Clin Psychiatry., (2002), 63 pp. 826-837
[29]
H.G. Ruhé
2023083106260693644
, J. Huyser, J.A. Swinkels, A.H. Schene.
Switching antidepressants after a first selective serotonin reuptake inhibitor in major depressive disorder: a systematic review.
J Clin Psychiatry., (2006), 67 pp. 1836-1855
[30]
U. Reichenpfader
2023083106260693645
, G. Gartlehner, L. Morgan.
Sexual dysfunction associated with second generation antidepressants in patients with major depressive disorder: Results from a systematic review with network meta-analysis.
[31]
Rush
2023083106260693646
AJ. Unipolar major depression in adults: Choosing initial treatment. UpToDate. 2020. Disponible en: www.uptodate.com.
[32]
A. Schatzberg
2023083106260693647
, C. Nemeroff.
The American Psychiatric Association Publishing Textbook of Psychopharmacology.
(2017),
[33]
K. Wenzel-Seifert
2023083106260693648
, M. Wittmann, E. Haen.
QTc prolongation by psychotropic drugs and the risk of torsade de pointes.
Dtsch Arztebl Int., (2011), 108 pp. 687
[34]
G. McLachlan
2023083106260693649
.
Treatment resistant depression: what are the options?.
BMJ [Internet]., (2018), 363 pp. k5354
[35]
S. Mohamed
2023083106260693650
2023083106260693651
, G.R. Johnson, P. Chen, P.B. Hicks, L.L. Davis, J. Yoon, et al.
Effect of antidepressant switching vs augmentation on remission among patients with major depressive disorder unresponsive to antidepressant treatment.
JAMA - J Am Med Assoc, (2017), 318 pp. 132-145
[36]
P. Davies
2023083106260693652
2023083106260693653
, S. Ijaz, C.J. Williams, D. Kessler, G. Lewis, N. Wiles.
Pharmacological interventions for treatment-resistant depression in adults.
Cochrane Database Syst Rev., (2019), 12 pp. CD010557
[37]
A.J. Rush
2023083106260693654
, D. Warden, S.R. Wisniewski, M. Fava, M.H. Trivedi, B.N. Gaynes, et al.
STAR*D.
[38]
Y. Fang
2023083106260693655
, C. Yuan, Y. Xu, J. Chen, Z. Wu, L. Cao, et al.
A pilot study of the efficacy and safety of paroxetine augmented with risperidone, valproate, buspirone, trazodone, or thyroid hormone in adult chinese patients with treatment-resistant major depression.
J Clin Psychopharmacol., (2011), 31 pp. 638-642
[39]
M. Bauer
2023083106260693656
, L. Dell’Osso, S. Kasper, W. Pitchot, E.D. Vansvik, J. Köhler, et al.
Extended-release quetiapine fumarate (quetiapine XR) monotherapy and quetiapine XR or lithium as add-on to antidepressants in patients with treatment-resistant major depressive disorder.
J Affect Disord., (2013), 151 pp. 209-219
[40]
A.J. Bradley
2023083106260693657
, A.J. Lenox-Smith.
Does adding noradrenaline reuptake inhibition to selective serotonin reuptake inhibition improve efficacy in patients with depression? A systematic review of meta-analyses and large randomised pragmatic trials.
J Psychopharmacol., (2013), 27 pp. 740-758
[41]
E.J. Daly
2023083106260693658
, J.B. Singh, M. Fedgchin, K. Cooper, P. Lim, R.C. Shelton, et al.
Efficacy and safety of intranasal esketamine adjunctive to oral antidepressant therapy in treatment-resistant depression: A randomized clinical trial.
JAMA Psychiatry., (2018), 75 pp. 139-148
[42]
C.M. Canuso
2023083106260693659
, J.B. Singh, M. Fedgchin, L. Alphs, R. Lane, P. Lim, et al.
Efficacy and safety of intranasal esketamine for the rapid reduction of symptoms of depression and suicidality in patients at imminent risk for suicide: Results of a double-blind, randomized, placebo-controlled study.
Am J Psychiatry [Internet]., (2018), 175 pp. 620-630
[43]
G. Sanacora
2023083106260693660
2023083106260693661
, M.A. Frye, W. McDonald, S.J. Mathew, M.S. Turner, A.F. Schatzberg, et al.
American Psychiatric Association (APA) Council of Research Task Force on Novel Biomarkers and Treatments. A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders.
JAMA Psychiatry, (2017), 74 pp. 399-405
[44]
L.N. Yatham
2023083106260693662
, S.H. Kennedy, S.V. Parikh, A. Schaffer, D.J. Bond, B.N. Frey, et al.
Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder.
Bipolar Disord., (2018), 20 pp. 97-170
[45]
I. Pacchiarotti
2023083106260693663
, G. Anmella, L. Colomer, E. Vieta.
How to treat mania.
Acta Psychiatr Scand., (2020), 142 pp. 173-192
[46]
J. Hunt
2023083106260693664
.
Manic-depressive illness: Bipolar disorders and recurrent depression.
J Am Acad Child Adolesc Psychiatry., (2008), 47 pp. 1208-1209
[47]
A. Bermejo
2023083106260693665
Pastor, Í. Alberdi Páramo.
Trastorno bipolar, ciclotimia, suicidio y trastornos puerperales.
En: Manual de psiquiatría, 2a ed, Amir Salud, S.L, (2021),