Publicado Veja Saúde artigo de Dr. Acioly Lacerda, psiquiatra* - Atualizado em 21 set 2020, 15h38 - Publicado em 21 set 2020, 12h13
A depressão é uma doença cerebral que acomete cerca de 350 milhões de pessoas no mundo. De forma preocupante, registrou-se um aumento de 18% no número de cidadãos com o problema em apenas uma década. Embora seja uma doença com características primariamente emocionais e comportamentais, a depressão apresenta várias repercussões no organismo como um todo. Pessoas com depressão encaram maior risco de desenvolver condições como obesidade, diabetes, doenças cardiovasculares e câncer. Todos esses fatores contribuem para uma impressionante redução de dez anos na expectativa de vida de indivíduos com o transtorno.
Recentemente, a depressão conquistou o desafortunado título de principal causa de incapacidade no mundo, superando as doenças cardiovasculares. O crescimento marcante da incapacidade causada por esse problema é explicado por diferentes fatores. Primeiro, a depressão é uma doença altamente prevalente, acometendo cerca de 17% das pessoas ao longo da vida.
Segundo, é considerada uma doença crônica de jovens, já que 80% dos casos têm seu início antes dos 30 anos de idade e cifra semelhante apresenta múltiplos episódios depressivos durante a vida. Terceiro, a despeito da disponibilidade de cerca de 55 antidepressivos diferentes, um em cada três pacientes com depressão não melhora após o tratamento, situação que caracteriza a chamada depressão resistente ao tratamento.
![](data:image/jpeg;base64,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)
Médicos aguardam aprovação no país de novo remédio capaz de tratar quadros de depressão resistente. Ilustração: Erika Onodera/SAÚDE é Vital
A depressão resistente está associada a prejuízos ainda maiores. Pacientes nessa condição apresentam maior grau de incapacitação, têm um risco de internação três vezes maior e, quando internados, apresentam hospitalizações mais longas.
Desde o lançamento do primeiro antidepressivo há mais de meio século, há um considerável esforço da indústria farmacêutica no desenvolvimento de novas moléculas para o tratamento da depressão. Um erro estratégico, porém, parece ter ocorrido nessa corrida: os cerca de 55 princípios ativos criados desde então apresentam essencialmente o mesmo mecanismo de ação, o aumento de neurotransmissores como serotonina, noradrenalina e dopamina, todos pertencentes ao grupo das chamadas monoaminas.
Há cerca de 20 anos, a comunidade científica internacional recebeu com entusiasmo os resultados de uma pesquisa demonstrando um efeito antidepressivo robusto e ultrarrápido (já nas primeiras horas após a infusão) de doses baixas de cetamina, um antigo anestésico. Ao contrário dos antidepressivos tradicionais, a cetamina atua em outro neurotransmissor (o glutamato) e tem se mostrado bastante eficaz no tratamento de quadros resistentes de depressão.
Essa descoberta inaugurou uma nova era no tratamento da depressão, a partir da identificação de moléculas que tratam satisfatoriamente os quadros de depressão resistente, com melhora dos sintomas quase que imediata, o que tem sido descrito no meio cientifico como o principal avanço terapêutico nos últimos 50 anos.
A demonstração de sua eficácia e segurança em diversos estudos garantiu a aprovação da cetamina nos Estados Unidos e na Europa em 2019. Tendo por base tais resultados, ela tem sido usada off label no no Brasil em diversas clínicas em sua apresentação injetável. Neste momento, a Agência Nacional de Agência Sanitária (Anvisa) analisa dossiês científicos para aprovação final em bula de sua indicação para o tratamento de quadros de depressão resistente. E isso representa um novo alento para cerca de 10 milhões de pessoas que não se beneficiam dos tratamentos atualmente aprovados no Brasil.
* Dr. Acioly Lacerda é psiquiatra, professor da Universidade Federal de São Paulo (Unifesp) e coordenador do Programa de Transtornos Afetivos (Prodaf) da mesma instituição.
Leia mais em: https://saude.abril.com.br/blog/com-a-palavra/quando-a-depressao-resiste-ao-tratamento/