Nöropatik ağrı modelinde mirtazapinin etkinliği

Amaç: Kronik ağrı olan nöropatik ağrı bireylerin yaşam kalitesini etkileyeblir ve depresyon, anksiyete bozukluğu gibi psikiyatrik bozukluklara neden olabilir. Mirtazapin hem noradrenerjik, hem de özgül serotonerjik reseptör antagonisti olan atipik bir antidepresandır. Antidepresan etkisi yanında anksiyolitik, antiemetik ve iştah açıcı etkilerinin olduğu da gösterilmiştir. Mirtazapin nöropatik ağrı tedavisinde kullanılan diğer antidepresanlarlardan farklı bir etki yoluna sahiptir ve genel olarak daha iyi tolere edilir. Bu nedenle çalışmamızda sinir ligasyonu yapılan rat modelinde mirtazapinin nöropatik ağrıdaki koruyucu etkinliğini araştırmayı amaçladık. Yöntem: Kırk rat beş gruba ayrıldı. İlk grup sham grubu, ikinci grup sadece siyatik sinir ligasyonu yapılan gruptu. Üçüncü, dördüncü ve beşinci gruplara siyatik sinir ligasyonunun ardından sırasıyla 5 mg, 10 mg ve 15 mg/gün mirtazapin verildi. Grupların hepsine tail flick ve hot plate testleri yapıldı, latans süreleri ölçüldü. Mirtazapinin nöropatik ağrıda analjezik etkinliğinin dışında pozitif kontrol ajanı olarak kullandığımız morfin üzerine etkisi de değerlendirildi. Bulgular: Nöropatik ağrıda mirtazapinin tail flick ve hot plate latanslarında doza bağlı olumlu etkilerinin olduğu ve morfine verilen antinosiseptif yanıtı da önemli ölçüde geri kazandırdığı sonucuna vardık. Tartışma: Mirtazapin, nörotransmitterler üzerinden ikili etkisi ile hem nöropatik ağrı tedavisi, hem de eşlik eden depresyon, anksiyete gibi psikiyatrik bozukluklar için iyi bir aday olarak görünmektedir. (Anadolu Psikiyatri Derg 2020; 21(5):461-467)

Efficacy of mirtazapine in neuropathic pain model

Objective: Neuropathic pain, which is chronic pain, can affect the quality of life individuals. It can cause psychiatricproblems such as depression and anxiety. Mirtazapine is an atypical antidepressant which has both noradrenergicand specific serotonergic receptor antagonism and shown to have anxiolytic, anti-emetic and appetite stimulatingeffects along with its antidepressant effect. It is generally tolerated better and has a different way of action whencompared with other antidepressants used to treat neuropathic pain. Thus, we aimed to investigate its potentialpreventive effect in neuropathic pain in nerve ligated rat model. Methods: Forty rats were divided into five groupsincluding the sham, the sciatic nerve ligation group and the third, fourth and fifth sciatic nerve ligation+mirtazepinegroups which were treated with 5 mg, 10 mg and 15 mg/day mirtazapine, respectively. The tail flick and hot platetests were performed on all the five groups, and the latency times were measured. Morphine was used as a positivecontrol agent. Results: Administration of mirtazapine, restored both tail flick and hot plate latencies in a dosedependent manner, meaning that mirtazapine is effective in treating neuropathic pain in this animal model. Mirtazapine also restored the antinociceptive response to morphine significantly. Discussion: Mirtazapine appears tobe good candidate for both neuropathic pain treatment and accompanying psychiatric condition such as depressionand anxiety with its dual effect on neurotransmitters. (Anatolian Journal of Psychiatry 2020; 21(5):461-467)

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