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Diyabetik Nöropatili Hastaların Nöropatik Ağrı ve Depresyon Tedavisinde, Antidepresan ve Antiepileptik Kullanımı: Bir Karşılaştırma Çalışması

Amaç: Bu çalışmada, diyabetik nöropati (DN) hastalarında antidepresan olan amitriptilin ve venlafaksin SR ile antiepileptik olan lamotirijin ve okskarbazepinin ağrı ve depresyon üzerindeki etkilerinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Diyabetik nöropati tanısı konmuş hastalara nöropatik ağrı değerlendirmesine yönelik vizüel analog skala (VAS) ve Short-McGill ağrı anketi (SMAA) ile birlikte depresyon değerlendirmesinde kullanılan Beck Depresyon Envanteri (BDE) uygulanmasını takiben, rastgele ve randomize bir şekilde lamotrijin (2x50 mg/gün), okskarbazepin (2x300 mg/gün), amitriptilin (25 mg/gün) ve venlafaksin SR (75 mg/gün) tedavi rejimlerinden biri başlanmıştır. Hastalar 15 günlük aralarla toplam 6 kez kontrole çağrılmış ve her kontrolde VAS skorları ölçülmüştür. 6. ve son kontrolde ise VAS'a ek olarak SMAA ve BDE skorları ölçülmüştür. Bulgular:Tüm gruplarda, tedavi öncesi ve tedavi sonrası son BDE ve SMAA değerleri arasında istatistiksel olarak anlamlı farklılık saptanmıştır (p<0.05). Başlangıç VAS skorları benzer olan tüm tedavi gruplarında, 15. ve 30. ve 90. günlerde yapılan değerlendirmelerde VAS skorlarının tüm gruplar arasında istatistiksel olarak anlamlı farklılık gösterdiği saptanmıştır (p<0.05). Sonuç olarak lamotirijin ve okskarbazepin depresyon üzerinde amitriptilin ve venlafaksin SR kadar etkili olduğu bulunmuştur. Sonuç: Ağrılı DN ve eşlik eden depresyon varlığında antiepileptik ve antidepresanların benzer etkili olmaları tedavi alternatiflerinin arttırılması ve tedavinin kişiselleştirilmesine katkıda bulunması açısından önemlidir. Anahtar kelimeler: Diyabetik Nöropati; Depresyon; Okskarbazepin; Lamotrijin; Venlafaksin; Amitriptilin.

Anahtar Kelimeler:

Diyabetik Nöropati; Depresyon; Okskarbazepin; Lamotrijin; Venlafaksin; Amitriptilin.

Antiepileptic and Antidepressant Drugs in the Treatment of Neuropathic Pain and Depression of the Patients with Diabetic Neuropathy: A Comparative Study

Objective: The aim of this study is to investigate the effects of two antidepressants; amitryptline, venlafaxine XR, and two anticonvulsants lamotrigine, oxcarbazepine on pain and depression in diabetic neuropathy (DN). Material and methods: Following the visual analog scale (VAS), Short-McGill pain questionnaire (SMPQ) and Beck depression inventory (BDI) performance, patients with diabetic neuropathy were randomly treated with lamotrigine (2x50 mg/day), oxcarbazepine (2x300 mg/day), amitryptiline (25 mg/day), or venlafaxine XR (75 mg/day). Patients presented to 6 follow-up visits, within 15 days of intervals. VAS scores were re-measured in each follow-up visits, whereas SMPQ and BDI scores were performed at the end of the study. Results: There were statistically significant differences between the BDI and SMPQ scores of the all study groups before treatment and at the last follow-up visit (p<0.05).Initial VAS scores were similar in the study groups, whereas VAS scores in the day 15, 30 and 90 revealed statistically significant differences in all groups (p<0.05). Lamotrigine and oxcarbazepine were found as effective as amitryptiline and venlafaxine XR on depression. Conclusion: Similar efficacity of antiepileptic and antidepressants in the precence of painful DN and depression is important to contribute in personalization of the treatments and to increase the therapeutic options. Key words: Diabetic Neuropathy; Depression; Oxcarbazepine; Lamotrigine; Venlafaxine; Amitriptyline.

Keywords:

Diabetic Neuropathy; Depression; Oxcarbazepine; Lamotrigine; Venlafaxine; Amitriptyline.,

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