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2. $GHSUHVV]LyJ\yJ\V]HUHVNH]HOpVH

(EEHQ D IHMH]HWEHQ U|YLGHQ EHPXWDWRP D] DQWLGHSUHVV]iQV J\yJ\V]HUNLQFVQNHW $

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transzporter (SERT serotonin transzporter), noradrenalin transzporter (NET,
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preszinaptikus neuronokba, s ez iOWDO PDJDV NRQFHQWUiFLyEDQ OHV]Qek jelen a
posztszinaptikus receptorokon. [7.]

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UHFHSWRUKR] N|WĘGQHN $ JiWOiV DQWDJRQL]iOiVD PLDWW IRNR]]iN D QRUDdrenalin
IHOV]DEDGXOiVW>7.]

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V]HULQWOHJDOiEE-4 hpt szNVpJHVDWQHWPHQWHVVpJHOpUpVpLJ>10.]

8  
 
  

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V]LJRU~ WiSOiOkR]iVL PHJV]RUtWiVRNDW WDUWDni. [11.] $ FVRSRUWED WDUWR]y
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jeOHQWĘVHQ pV WDUWyVDQ PHJQ|YHOLN D V]LQDSWLNXV UpVben a monoamin
NRQFHQWUiFLyMiW>7.]

9  
 
  

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$N|YHWNH]ĘOpSpVD]DQWLGHSUHVV]iQVWHUiSLiEDQDz 1970-HVpYHNWĘl az 1990-es

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V]HURWRQLQ YLVV]DYpWHOpW [10.] Nem rendelkeznek antikolinerg,
DQLKLV]WDPLQHUJ pV DQWLDGUHQHUJ KDWiVVDO >10.] $ FVRSRUWED WDUWR]y
YHJ\OHWHN IOXR[HWLQ IOXYR[DPLQ SDUR[HWLQ VHUWUDOLQ FLWDORSUDP,
escitalopram
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6]pOHVWHUiSLiVV]pOHVVpJNPLDWWDW~ODGDJROiVRV|QJ\LONRVViJQHKH]HEE
[10.]

10  
 
  

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$QWLGHSUHVV]iQV KDWiVXN QHP P~OMD IHOO D WULFLNOXVRV
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Az 1980-DV pYHN HOHMpQ IHMOHV]WHWWpN NL D NRUiEEL PRQRDPLQR[LGi] JiWOyNQiO

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UpVEHUOĘPHQQ\LVpJN[16.]
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DNHULQJpVEHQHPRNR]KLSHUWyQLiVUHDNFLyW.  [10.]  
2.2.5. ÒMDEEDQWLGHSUHVV]iQVRN

Az 1990-HVpYHNWĘOD-HVpYHNLJNLIHMOHV]WHWWJ\yJ\V]HUHNQHPVRUROKDWyDN
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LGHDN|YHWNH]ĘNEHQH]HNHWLVPHUWHWHPU|YLGHQ [17.]
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$FVRSRUWYHJ\OHWHLYHQODID[LQGXOR[HWLQ
0LQGNpW J\yJ\V]HU JiWROMD mind a norepinefrin, mind a szerotonin
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V]LQWpQ PLQGNpW LQJHUOHWiWYLYĘ YLVV]DYpWHOpW JiWROMiN), hogy nem
PXWDWKDWy NL HJ\LN J\yJ\V]HU HVHWpEHQ VHP DQWLNROLQHUJ DQWLDGUHQHUJ
DQWLKLV]WDPLQHUJDNWLYLWiVHPLDWWDWULFLNOXVRVQHPV]HOHNWtYYLVV]DYpWHO
JiWOyNUDMHOOHP]ĘV~O\RVPHOOpNKDWiVDLNQHPMHOHQWNH]QHN>7.]

11  
 
  

2.2.5.2. Noradrenalin dopamin reuptake inhibitorok (ND R I)

A bupropion J\HQJpQ JiWROMD D QRUDGUHQDOLQ pV D GRSDPLQ QHXURQiOLV
YLVV]DYpWHOpW [7.] Csak mLQLPiOLV V]HURWRQLQ UHXSWDNH LQKLELWRU KDWiVD
van.[18.] Nem hat az adrenerg, hisztaminerg, kolinerg rendszeren sem,
HPLDWW QHP RNR]QDN V]H[XiOLV YiOWR]iVRNDW WHVWV~O\Q|YHNHGpVW MyO
WROHUiOKDWyDN. [7.]
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$PLUWD]DSLQpVDPLDQV]HULQEORNNROMiNDSUHV]LQDSWLNXVĮ2-receptorokat,
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UpVEHQ[7.]
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$ WUD]RGRQ JiWROMD D V]HURWRQLQ YLVV]DYpWHOpW pV D] -HT2-receptorokat.
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DV]HURWRQLQIHOYpWHOpWDW|EELDQWLGHSUHVV]iQVVDOV]HPEHQ0HOOpNKDWiV-
SURILOMDDWULFLNOXVRVV]HUHNpKH]KDVRQOtWGHD]RNpQiOHQ\KpEE>7.]

2.3. gVV]HIRJODOiV

$] HOĘ]ĘHNEHQ D WHOMHVVpJ LJpQ\H QpONO LVPHUWHWWHP D] DQWLGHSUHVV]iQV

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|VV]H

12  
 
  

IWiEOi]DW

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3. 0HOOpNKDWiVRN

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16  
 
  

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17  
 
  

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18  
 
  

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19  
 
  

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10 mg/25 mg/50 mg filmtabletta, clomipramin: Anafranil 10 mg/25
mg/ 75 mg (SR) filmtabletta, Maprotilin: Ludiomil 10 mg/25 mg/75
mg filmtabletta, )OXR[HWLQ 3UR]DF  PJ  PO EHOVĘOHJes oldat,
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Paroxetin: Seroxat 20 mg filmtabletta, Escitalopram: Cipralex 10 mg

27  
 
  

filmtabletta, Aurorix 150 mg/300 mg filmtabletta, bupropion:

Wellbutrin SR 150 mg retard tabletta, duloxetin: Cymbalta 30 mg
J\RPRUQHGY HOOHQiOOy WDEOHWWD PLDQV]HULQ 7ROYRQ  PJ
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tabletta, trazodon: Trittico AC 75 mg / 150 mg retard tabletta,
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28  
 
  

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33  
 
  

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teljes EHWHJSRSXOiFLyUD
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KRJ\ ~J\ LV YDQ s HNNRU QDJ\REE HVpOO\HO G|QW D IHOWHWW NpUGpV HOYHWpVe, vagy
J\DQ~MiQDN PHJHUĘV|GpVe mellett +D NHYpV URVV]DEE PLQĘVpJĦ YL]VJiODW YDQ,
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34  
 
  

4iEUD>@

PHWDDQDOt]LVHN
szisztematikus
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(EEHQ D UpV]EHQ V]HUHWQpP LVPHUWHWQL KRJ\ D J\yJ\V]HUpUWpNHOpVHN VRUiQ PLN D

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ாாோ
- 6]iPtWiVDܴܴ ൌ ஼ாோ [45.]
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- EER= , [45.]
௕௘௧௘௚௘௞௦௭ž௠௔௔௩௜௭௦௚ž௟௔௧௜௖௦௢௣௢௥௧௕௔௡
௘௦௘௠±௡௬௘௞௦௭ž௠௔௞௢௡௧௥௢௟௟௖௦௢௣௢௥௧௕௔௡
- CER= [45.]
௕௘௧௘௚௘௞௦௭ž௠௔௔௞௢௡௧௥௢௟௟௖௦௢௣௢௥௧௕௔௡

- eUWHOPH YL]VJiOW FVRSRUWEDQ pV]OHOW J\DNRULViJ KiQ\DG UpV]H D NRQWUROO

FVRSRUWpQDN[45.]

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஼ாோିாாோ ாாோି஼ாோ
- 6]iPtWiVD555 RRI= [45.]
஼ாோ ஼ாோ

35  
 
  

- eUWHOPH]pVHDYL]VJiOWFVRSRUWEDQKiQ\V]i]DOpNNDOFV|NNHQWYDJ\QĘWWD]
HVHPpQ\J\DNRULViJDDNRQWUROOFVRSRUWKR]Nppest. 5HODWtYPHUWDNRQWUROO
FVRSRUWKR] NpSHVW YLV]RQ\tW +iWUiQ\D KRJ\ QHP IHMH]L NL D] HVHPpQ\
YDOyGLJ\DNRULViJiWDSRSXOiFLyEDQ [45.]
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(A R I)

- 6]iPtWiVD$55 &(5-EER, ARI=EER-CER [45.]

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&(5HEEĘO NLYRQMXNKRJ\DYL]VJiOWFVRSRUWEDQPLO\HQ J\DNRULViJJDO
IRUGXOHOĘtJ\PHJNDSMXNKRJ\WpQ\OHJHVHQKiQ\V]i]DOpNNDONHYHVHEEV]HU
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- 6]iPtWiVD$ODSMDD]HVpO\pUWpN(VpO\pUWpN HVHPpQ\HNV]iPDDYL]VJiOW
YDJ\ NRQWUROO FVRSRUWEDQ QHP N|YHWNH]HWW EH HVHPpQ\ D YL]VJiOW YDJ\
kontroll csoportban. [45.]
೐ೞ೐೘±೙೤೐ೖೞ೥ž೘ೌೌೡ೔೥ೞ೒ž೗೟೎ೞ೚೛೚ೝ೟್ೌ೙
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- eUWHOPH]pVH$NH]HOWFVRSRUWEDQKiQ\V]RURVDD]HVHPpQ\HOĘIRUGXOiViQDN
DNRQWUROOFVRSRUWKR]NpSHVW [45.]
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DJ\yJ\V]HUN|YHWNH]PpQ\HOHJ\HQ11+KiQ\EHWHJHWNell kezelni ahhoz,
KRJ\ HJ\ EHWHJQpO D PHOOpNKDWiV D J\yJ\V]HU N|YHWNH]PpQ\HNpQW OpSMHQ
fel. [45.]

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36  
 
  

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4.5.2. Szignifikancia szint

Megadja a nullKLSRWp]LV KLEiVHOYHWpVpQHNYDOyV]tQĦVpJpW. [45.] Azt fejezi ki,

KRJ\PHNNRUDDYDOyV]tQĦVpJHDQQDNKRJ\DWDOiOWNO|QEVpJDYpOHWOHQPĦYH
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37  
 
  

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NDSFVRODWEDQUHQGHONH]pVUHiOOyLQIRUPiFLyNDW

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PiVUpV]DNO|QOHJHVILJ\HOPH]WHWpVHNSRQWDODWW$N|YHWNH]ĘNEHQLVPHUWHWHPD]
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|VV]HJ\ĦMWĘWiEOi]DWRNEDQ [40.]
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DQWLGHSUHVV]iQVRNQiONLYpWHOQpONOQHPLVPHUWJ\DNRULViJ~NpQWIRUGXOWDNHOĘ
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D]DQWLGHSUHVV]iQVVDONH]HOWFVRSRUWEDn, mint a placebo csoportban.
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a placebo csoportban

38  
 
  

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39  
 
  

,,WiEOi]DW
9L]VJiODW 0LYROWDFpOMD" K iket 0LO\HQWtSXV~ 0LYROWD]HUHGPpQ\H" +iQ\DQYROWDND K ontroll csoport
YL]VJiOWDN" YL]VJiODW" YL]VJiODWEDQ"
1. T eicher IOXR[HWLQW V]HGĘ HVHWWDQXOPiQ\ EHWHJQHN|QJ\LONRVViJLJRQGRODWDLOHWWHN
1990 betegek DPHJYRQiVXWiQ
[46.]

2. J A M A Jick |QJ\LONRVViJL YLVHONHGpV pV 10- pYHV eset kontroll x 1LQFV NO|QEVpJ D KDWyDQ\DJRN 159 810 beteg GRWKLHSLQW V]HGĘN PiVLN
2004 JRQGRODWRN UHODWtY NRFNi]DWD betegek, akik 4 N|]|WW D] |QJ\LONRVViJL KDMODP pYHVLGĘV]DNDODWW DQWLGHSUHVV]iQVKR]
[47.] DQWLGHSUHVV]iQV WHUiSLiW NH]GĘN antiGHSUHVV]iQV IRNR]yGiViEDQ D GRVXOHSLQKH] YLV]RQ\tWYD
N|UpEHQ N|]O HJ\LNHW YLV]RQ\tWYD
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szedni x amitriptilin OR=0,83 CI=0,61-1,13
(nem tudjuk x fluoxetin OR=1,16 CI= 0,9-1,13
milyen x paroxetin OR=1,29 CI= 0,97-1,7
EHWHJVpJEHQ x $ IHOtUiVW N|YHWĘ HOVĘ LGĘV]DNEDQ
PDJDVDEED]|QJ\LONRVViJLNRFNi]DW
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CI=6,2-231
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2001 SV]LFKRIDUPDNROyJLDLNH]HOpVWD] HON|YHWĘN |QJ\LONRVViJHOĘWWL
[48.] |QJ\LONRVViJHOĘWWD]RN, akik pYHVLGĘWDUWDP 30 napban
|QJ\LONRVViJRWN|YHWWHNHO alatt
4. M artinez |QJ\LONRVViJRNpV|QJ\LONRVViJL 10-pYHV eset kontroll x SSRI-k nem hordoznak nagyobb 146 095 WULFLNOXVRVDQWLGHSUHVV]iQV
2005 NtVpUOHWHN665,-WV]HGĘNN|]|WWD DQWLGHSUHVV]iQVW NRFNi]DWRWD7&$'-RNQiO DQWLGHSUHVV]iQVW
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V]HGĘNK|]NpSHVW OR=0,99 CI (95%)= 0,86-1,14
x KDOiORVNLPHQHWHOĦ|QJ\LONRVViJ
OR=0,57 CI (95%)=0,26-1,25
x Gyerekkorban (10-pYHVHNQpO
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[50.] YpUpQHNWR[LNROyJLDLDQDOt]LVH HON|YHWĘN WR[LNROyJLDLDQDOt]LVWN|YHWĘHQ
VRUiQKiQ\QiOWDOiOWDN
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36  
 
  

9L]VJiODW 0LYROWDFpOMD" K iket 0LO\HQWtSXV~ 0LYROWD]HUHGPpQ\H" +iQ\DQYROWDND K ontroll csoport

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[51.] KDWiVRVViJiQDNpV gyerekek NRQWUROOiOW SODFHERFVRSRUWKR]NpSHVW kezelt, 464
EL]WRQViJRVViJiQDNiWWHNLQWpVH klinikai SMD=0,26 CI=(95%) 0,13-0,4 placeboval kezelt
YL]VJiODW x EL]WRQViJRVViJDOiEHFVOWpND gyerek
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Mosholder KR]NpSHVW (mirtazapin, YL]VJiODWRN DUiQ\D25 &, -3,21), J\yJyV]HUWV]HGĘ
2004 nefazodon, iWWHNLQWpVH S65,YL]VJiODWRN|VV]HVtWpVpEHQ pVSODFHEyW
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GHSUHVV]LyVJ\HUHNHNQpO
fOXR[HWLQEL]WRQViJRV
8. K ahn 2003 |QJ\LONRVViJRNDUiQ\iQDN SSRI-WHJ\pE UDQGRPL]iOW nincs MHOHQWĘV NO|QEVpJVHPD] SiFLHQV SODFHERNRQWUROOiOW
[52.] |VV]HKDVRQOtWiVD665,-WPiV DQWLGHSUHVV]iQVW NRQWUROOiOt DQWLGHSUHVV]iQVRNpVDSODFHERN|]|WW
DQWLGHSUHVV]iQVWpVSODFHERWNDSy (pl nefazodon, klinikai sem az SSRI-NpVPiVDQWLGHSUHVV]iQVRN
HJ\pQHNQpO trazodon, YL]VJiODWRN N|]|WWSSRI (0.59%, 95% confidence
bupropion, iWWHNLQWpVH interval [CI]=0.31%-0.87%), a standard
maprotilin) DNWtYNRQWUROO&, -
V]HGĘIHOQĘWWHN 1.03%), placebo (0.45%, 95% CI=0.01%-
0.89%)
9. W hittington SSRI-NKDWiVRVViJDpV 5-pYHV UDQGRPL]iOW gQJ\LONRVViJLYLVHONHGpVpV OHJW|EE SODFHERNRQWUROOiOW
2004 EL]WRQViJRVViJiQDN GHSUHVV]LyV NRQWUROOiOW |QJ\LONRVViJLHVHWHNUHODWtYNRFNi]DWD YL]VJiODWEDQ
[53. ] megiOODStWiVDSXEOLNiOWpVQHP gyerekek YL]VJiODWPHWD- x fluoxetin: (RR=0,94 CI=0,37-2,40, kevesebb, mint 200
SXEOLNiOWYL]VJiODWRN DQDOt]LVH RR=1,26 CI=0,36-4,40) IĘYHV]UpV]WPLQGD
|VV]HJ]pVpYHO x paroxetin RR= 10,30 CI=0,58- placebo, mind a
183,53 kontroll csoportban
x sertralin RR=2,43 CI=0,48-12,39 PD[LPXPIĘ
x citalopram RR=1,99 CI= 0,83-4,77
x venlafaxin RR=13,77 CI=1,83-
103,61

37  
 
  

9L]VJiODW 0LYROWDFpOMD" K iket 0LO\HQWtSXV~ M i volt az HUHGPpQ\H" +iQ\DQYROWDND K ontroll csoport

YL]VJiOWDN" YL]VJiODW" YL]VJiODWEDQ"
10. G unnel, IHOQĘWWHNQpO665,-k okoznak-e DQWLGHSUHVV]iQVW UDQGRPL]iOW x |QJ\LONRVViJRN|VV]HVtWHWWNRFNi]DWD 40 UpV]WYHYĘ SODFHERNRQWUROOiOW
Ashby 2005 maJDVDEE|QJ\LONRVViJL V]HGĘIHOQĘWWHN NRQWUROOiOW OR=0,74 CI (95%)=0,25-2,21
[54.] NRFNi]DWRW DSODFHEyKR]NpSHVW YL]VJiODWPHWD x 1HPKDOiORV|QJ\LONRVViJL
DQDOt]LVH NtVprletek OR=1,26 CI (95%) =0,88-
1,80
x gQJ\LONRVViJLJRQGRODWRN25 
CI (95 %)= 0,53-1,26
x gQJ\LONRVViJpV|QNiURVtWy
PDJDWDUWiVQHP]iUKDWyNLEiUD
YL]VJiODWRNDODSMiQHUUHNHYpVD]
HVpO\J\HQJHEL]RQ\tWpNYDQUi
KRVV]DEEN|YHWpVLLGHMĦYL]VJiODWRN
OHQQpQHNV]NVpJHVHN

38  
 
  

5.4. 0LpUWV]NVpJHVHNDEL]RQ\tWpNRNRQDODSXOyRUYRVOiVPyGV]HUHLDNpUGpVUĘOa
YpOHPpQ\ NLDODNtWiViKR]"

5.4.1. A] iOWDODP IHOWHWW NpUGpV KRJ\ IRNR]]iN-H D] DQWLGHSUHVV]iQVRN D]
|QJ\LONRVViJLNRFNi]DWRWOiWV]yODJHJ\V]HUĦD]RQEDQDIHQWLHNEĘOOiWV]LNKRJ\
YDOyMiEDQW|EESUREOpPDN|UUHERQWKDWMXNIHO
5.4.1.1. 0HO\LNpOHWNRUEDQIRNR]yGLND]|QJ\LONRVViJLNRFNi]DW"
0iUD]DONDOPD]iVLHOĘtUiVRNEyOLVOiWV]RWWKRJ\YDODPLNpSSNO|QNHOO
NH]HOQLDJ\HUHNpVDIHOQĘWWSRSXOiFLyW
5.4.1.2. 0LO\HQEHWHJVpJEHQV]HQYHGĘNnpOIRNR]yGLNDNRFNi]DW"
5.4.1.3. $NH]HOpVPHO\LGĘV]DNiEDQIRNR]RWWD]|QJ\LONRVsiJLNRFNi]DW"
$ NH]HOpV NRUDL LGĘV]DNiEDQ IRNR]RWW |QJ\LONRVViJL NRFNi]DW YDOyEDQ
QHP NtYiQW J\yJ\V]HUKDWiV" (] HOOHQWPRQGDQD DQQDN D NOLQLNDL
WDSDV]WDODWQDNKRJ\D]DQWLGHSUHVV]iQVKDWiVLGHMpQHNEHiOOWDDNiU-KpW
is lehet (21-QDS+LV]HQHNNRUPpJYDOyV]tQĦOHJQHPiOOWEHDKDWiV
azaz lehet PDJiQDN D GHSUHVV]LyQDN D N|YHWNH]PpQ\H LV 8J\DQDNNRU
DKRJ\ D] DONDOPD]iVL HOĘtUiVRNEyO NpV]tWHWW WiEOi]DWEDQ OiWV]LN D]
DQWLGHSUHVV]iQVRNQDNVDMQRVV]iPRVHJ\pEQHPNtYiQWKDWiVDYDQPHO\HN
URVV]KDWiVVDOOHKHWQHNDEHWHJHNpOHWPLQĘVpJpUH3pOGiXOJ\akori DEHOVĘ
nyugWDODQViJHUHNWLOLVGLV]IXQNFLyKiQ\LnJHUpPHO\JpVIHMIiMiV(]HND
KDWiVRN PiU D NH]HOpV NRUDL V]DNDV]iEDQ LV MHOHQWNH]KHWQHN V D WHVWL
URVV]XOOpWHUĘVtWKHWLDGHSUHVV]LyVRNDP~J\LVURVV]KDQJXODWiWH]iOWDOD]
HVWHOHJHV |QJ\LONRVViJL JRQGRODWRNDW (EEHQ D] pUWHOHPEHQ SHGLJ
N|]YHWHWW QHP NtYiQW J\yJ\V]HUKDWiVQDN WHNLQWKHWĘ D] |QJ\LONRVViJL
NRFNi]DWIRNR]yGiVD
5.4.2. $YL]VJiODWRNVRNIpOHPLQĘVpJĦHN
5.4.2.1. &pONLWĦ]pVHN
$] iOWDODP YL]VJiOW WDQXOPiQ\RN N|]|WW QHP YROW RO\DQ DPHO\EHQ D
UDQGRPL]iOW NRQWUROOiOW YL]VJiODWRN HOVĘGOHJHV FpONLWĦ]pVH DQQDN
PHJiOODStWiVD YROW KRJ\ IRNR]]iN-H D] DQWLGHSUHVV]iQVRN D]
|QJ\LONRVViJL NRFNi]DWRW (] YDODKRO pUWKHWĘ KD EHOHJRQGROXQN KD H]W
tUQiNLHJ\YL]VJiODWFpONLWĦ]pVHNpQWYDOyV]tQĦOHJD](WLNDL%L]RWWViJse
IRJDGQi HO KLV]HQ SRWHQFLiOLVDQ KDOiORV NLPHQHWHOĦ HVHPpQ\HNUĘO
EHV]pOQN WRYiEEi NL MHOHQWNH]QH HJ\ LO\HQ YL]VJiODWUD" 3OiQH KD

39  
 
  

GHSUHVV]LyV« (]HQ RNRN PLDWW D YL]VJiODWRN QDJ\ UpV]H V]LV]WpPiV

iWWHNLQWĘ PHWD-DQDOt]LV PHO\HN PHJSUyEiOMiN |VV]HIRgni azokat a
YL]VJiODWRNDWDKROPHJILJ\HOWpNH]HNHWDQHPNtYiQWHVHPpQ\HNHW
5.4.2.2. Eset-NRQWUROOYL]VJiODWRNSUREOpPiMD
$] HVHW NRQWUROO YL]VJiODWRN EiU QDJ\V]iP~ DGDWRW HOHPH]QHN H]iOWDO
FV|NNHQDYpOHWOHQKLEDHVpO\HFVDNNRUOiWR]RWWDQDGQDNLQIRUPiFLyWD]
DQWLGHSUHVV]iQVRN |QJ\LONRVViJ IRNR]y KDWiViUyO $] LO\HQ
YL]VJiODWRNEDQ QLQFV N|YHWpV tJ\ D] DGKHUHQFLD QHP WDQXOPiQ\R]KDWy
1HP WXGMXN KRJ\ D SiFLHQV PHQQ\LUH IRJDGWD HO EHWHJVpJpW V H] iOWDO
PHQQ\LUHpUWHWWHPHJDJ\yJ\V]HUHVNH]HOpVIRQWRVViJiW0LOyen volt az
orvos-beteg kapcsolat? Kapott-HPHOOHWWHSV]LFKRWHUiSLiW"
5.4.2.3. .RQWUROOFVRSRUWSUREOpPiMD
Gyakori volt, hogy nem alkalmaztak kontroOO FVRSRUWRW YDJ\ FVDN PiV
KDWyDQ\DJRNKR]NpSHVWQp]WpNPHJD]|QJ\LONRVViJLNRFNi]DWRW(]]HOD]
D SUREOpPD KRJ\ ha nem alkalmazunk placebo kontrollt, nem tudjuk
NLV]ĦUQLD]GHSUHVV]Ly|QJ\LONRVViJIRNR]yKDWiViW

5.5. %L]RQ\tWpNRNUDQJVRUROiVD

A YL]VJiODWRNVRNV]tQĦHN voltaktJ\QHKp]volt HJ\NDSWDIiUDYHQQLĘNHWpVHJ\

HJ\pUWHOPĦ N|YHWNH]WHWpVW OHYRQQL EHOĘON (]pUW DV]HULQW KRJ\ D YL]VJiODW FpOMD
PHQQ\LUHIHOHOWPHJD]iOWDODPIHOWHWWNpUGpVQHNPLO\HQPLQĘVpJĦYROWDYL]VJiODW
KiQ\DQ YROWDN D YL]VJiODWEDQ LOOHWYH KRJ\ DONDOPD]WDN-e kontroll csoportot,
SRQWR]iVLUHQGV]HUWDODNtWRWWDP NLpVH]DODSMiQUDQJVRUROtaPDIHQWLYL]VJiODWRW
$]pUWH]HNHWDV]HPSRQWRNDWYiODV]WRWWDP PHUWH]HNPHJIHOHOQHNDEL]RQ\tWpNRNRQ
DODSXOy RUYRVOiV DODSHOYHLQHN pV ~J\ JRQGRORP KRJ\ H]HN DODSMiQ WXGRP ĘNHW
YLV]RQ\ODJREMHNWtYHQ|VV]HKDVRQOtWDQL
$N|YHWNH]ĘNEHQLVPHUWHWHPDSRQWR]iVLUHQGV]HUHOHPHLWPDMGPDJukat a kapott
HUHGPpQ\HNHW
5.5.1. 3RQWR]iVLUHQGV]HU
5.5.1.1. 0LO\HQPLQĘVpJĦYROWDYL]VJiODW"
(VHWWDQXOPiQ\SRQW
Eset kontroll 2 pont
5DQGRPL]iOWNRQWUROOiOWYL]VJiODWSRQW
5DQGRPL]iOWNRQWUROOiOWYL]VJiOatok meta-DQDOt]LVHSRQW

40  
 
  

0LpUW tJ\ SRQWR]WDP" $ EL]RQ\tWpNRNRQ DODSXOy pUWpNHOpV HOYHLQHN

PHJIHOHOĘHQDPDJDVDEEEL]RQ\tWyHUHMĦQHNDGWDPW|EESRQWRW
5.5.1.2. Mennyire felelt meg az IHOWHWWNpUGpVQHNDYL]VJiODWFpOMD"
/HJLQNiEE PHJIHOHO  SRQW PDJDVDEE-H D] |QJ\LONRVViJL UiWD D]
antideSUHVV]iQVWV]HGĘNN|]|WWPLQWD]RNN|]|WW, akik nem szedtek?)
0pJHOpJMyOPHJIHOHOSRQW
.HYpVEpIHOHOPHJSRQW
/HJNHYpVEp IHOHO PHJ  SRQW QHP D] YROW D YL]VJiODW FpOMD KRJ\
|VV]HIJJpVWiOOtWVDQDNIHOFVDNYpOHWOHQOPHJILJ\HOWpN
0LpUWtJ\SRQWR]WDP"$QQiONHYHVHEESRQWRWNDSWDNDYL]VJiODWRNPLQpO
LQNiEE N|]YHWHWWHQOHKHWett FVDN|VV]HIJJpVWOHYRQQL
5.5.1.3. +iQ\DQYROWDNDYL]VJiODWEDQ"  
IĘDODWWSRQW
1000- 10.000 2 pont
10.000-100.000 3 pont
100.000 < 4 pont
0LpUW tJ\ SRQWR]WDP" $ OpWV]iP Q|YHOpVpYHO FV|NNHQ D YpOHWOHQ KLED
HVpO\HUHSUH]HQWDWtYDEEDEHYRQWSRSXOiFLy
5.5.1.4. KontrROOiOWYROW-HDYL]VJiODW"
1HPNRQWUROOiOWSRQW
0iVLNDQWLGHSUHVV]iQVKR]NpSHVWSRQW
Placebo kontroll: 3 pont
0LpUWtJ\SRQWR]WDP"$GHSUHVV]Ly|QJ\LONRVViJIRNR]yKDWiViWOHJMREEDQ
SODFHERFVRSRUWKR]YLV]RQ\tWYDV]ĦUKHWMNNL

41  
 
  

5.5.2. 7iEOi]DW

,,,WiEOi]DW

1990

2004

2001

2005

1994

2004

2005

2004

2005
J A M A Jick

Juredini
Isacsson
T eicher

A ndersen

M artinez

Mosholder
T rontell,

W hittington

G unnel, Ashby
K ahn 2003
9L]VJiODW

9L]VJiODW
1 2 1 2 1 4 4 4 4 4
PLQĘVpJH
0HJIHOHOĘVpJH 1 3 2 3 2 3 4 4 3 4
/pWV]iP 1 4 1 4 2 1 2 3 2 3
.RQWUROOiOW-
1 2 1 2 1 3 3 3 3 3
e?
gVV]HVHQ 4 11 5 11 6 11 13 14 12 14

5.5.3. A WiEOi]DWHOĘQ\HLKiWUiQ\DL
5.5.3.1. (OĘQ\|N
- N|QQ\HQiWOiWKDWyYiWHV]LDIHOGRlgozott szakirodalmat
- EL]RQ\tWpNRNRQDODSXOyRUYRVOiVHOYHLQHNHOHPHLWWDUWDOPD]]D
- V]iPV]HUĦVtWL D PHJEt]KDWyViJRW IHOWHWW NpUGpVQHN YDOy
PHJIHOHOĘVpJHW
-­‐ OiWKDWy KRJ\DNpUGpV HOVĘ IHOYHWĘGpVHXWiQKRJ\OHWW HJ\UHW|EE pV
MREEPLQĘVpJĦEL]RQ\tWpND]LGĘHOĘUHKDODGWiYDO
5.5.3.2. +iWUiQ\RN
- a szempontok nem biztos, KRJ\RSWLPiOLVDQYDQQDNV~O\R]YD
- HJ\V]HUĦVtWpVHNHWWDUWDOPD]
5.5.4. gVV]HJ]pV

gVV]HVVpJpEHQWHKiWDFpORPQHPD]YROWDWiEOi]DWHONpV]tWpVpYHOKRJ\DIHOWHWW
NpUGpVUH NRQNUpW YiODV]W DGMDN LJHQ IRNR]]iN D] DQWLGHSUHVV]iQVRN D]
|QJ\LONRVViJL NRFNi]DWRW LOOHWYH QHP QLQFV LO\HQ KDWiVXN KDQHP D] KRJ\
UHQGV]HUEHIRJODOMDPDIHOGROJR]RWWEL]RQ\tWpNRNDWVH] iOWDON|QQ\HEEHQ|VV]H
WXGMDPKDVRQOtWDQLD]DONDOPD]iVLHOĘtUiVRNEDQWDOiOWDNNDO$IHQWLWiEOizatban
NDSRWW HUHGPpQ\HN WHKiW QHP D] HUHGPpQ\HNUH KDQHP D PyGV]HUUH
vonatkoznak.

42  
 
  

5.6. +RJ\DQYLV]RQ\XOQDNHJ\PiVKR]D]DONDOPD]iVLHOĘtUiVRNpVDEL]RQ\tWpNRN"

A]DONDOPD]iVLHOĘtUiVRNV]HULQW a]DQWLGHSUHVV]iQVRNNDOYDOyNH]HOpVHOHMpQMREEDQ
oda kell figyeOQL D EHWHJHNUH PLYHO HNNRU PDJDVDEE OHKHW D] |QJ\LONRVViJL
NtVpUOHWHNV]iPD(]W N|]HSHVV]LQWĦEL]RQ\tWpNWiPDV]WMDDOiD]iOWDODPpUWpNHOW
YL]VJiODWRNN|]OSRQWRWNDSRWW-$0$-EDQPHJMHOHQWHVHWNRQWUROOYL]VJiODW(
YL]VJiODW NRQNO~]LyMD D] KRJ\ D NH]HOpV NpVĘEEL LGĘV]DNDLKR] NpSHVW PDJDVDEE
OHKHWD]|QJ\LONRVViJLUiWD9pOHPpQ\HPV]HULQWH]FVDNN|]YHWHWWHQNDSFVROKDWyD]
DQWLGHSUHVV]iQVRNKR] $ NH]HOpV HOHMpQ D] DQWLGHSUHVV]iQV KDWiVD PpJ QHP iOOW
IHOWpWOHQO EH YLV]RQW D W|EEL PHOOpNKDWiVD PiU jelentkezhet, emiatt rosszabbul
OHKHWQHNDEHWHJHNVIRNR]yGKDWQDNLO\HQLUiQ\~JRQGRODWDLN(]pUW~J\YpOHPD
NH]GHWL LGĘV]DNEDQ elengedhetetlen a gyakori orvRVL J\yJ\V]HUpV]L NRQWUROO
(OVĘVRUEDQ QHP D]pUW KRJ\ D] |QJ\LONRVViJL NtVpUOHWHNHW NLV]ĦUMpN, hiszen ez
QDJ\RQ QHKp] OHQQH PHJ D EHWHJ H]HNHW QHP IHOWpWOHQO YDOOMD EH $UUD QDJ\RQ
IRQWRV IHOKtYQL D SiFLHQV ILJ\HOPpW KRJ\ KD D] HOVĘ QpKiQ\ KpWHQ RO\DQ
PHOOpNKDWiVRNDW WDSDV]WDO PHO\HN QRUPiO pOHWYLWHOpW PHJQHKH]tWLN ]DYDUMiN,
IHOWpWOHQO M|MM|Q YLVV]D NRQ]XOWiOQL PLYHO QHP PLQGHQNL XJ\DQ~J\ UHDJiO D
J\yJ\V]HUHNUH VDMQRV HOĘIRUGXOKDWQDN LO\HQHN YLV]RQW OHKHWĘVpJ YDQ D WHUiSLD
iWiOOtWiViUD $ODSYHWĘ OHQQH LVPHUWHWQL YHOH KRJ\ PLO\HQ HJ\pE WHUiSLiV
OHKHWĘVpJHNHW YHKHW LJpQ\EH SpOGiXO SV]LFKRWHUDSHXWiW SV]LFKROyJXVW (]]HO
EL]DOPDWNHOWKHWQNEHQQHKRJ\IRQWRVQHNQND]KRJ\iOODSRWDMDYXOMRQVH]iOWDO
YDOyV]tQĦOHJ EiWUDEEDQ HOPRQGMD PDMG QHNQN D J\yJ\V]HUHOpV DODWW HVHtlegesen
MHOHQWNH]Ę SUREOpPiLW $EEDQ D] HVHWEHQ KD QHP PĦN|GLN D] DGRWW KDWyDQ\DJ
IHOWpWOHQO iW NHOO iOOtWDQL KD PLQGHQNpSS FVDN D J\yJ\V]HUHV WHUiSLiW YiODV]WMD
)RQWRV KRJ\ PLQGHQ HVHWEHQ D OHKHWĘVpJHN PHJLVPHUpVH XWiQ Ę G|QWKHVVHQ D
NH]HOpVUĘO
%iUYROWDNRO\DQYL]VJiODWRNPHO\HNV]HULQWIRNR]]iND]|QJ\LONRVViJRN DUiQ\iW
D] DQWLGHSUHVV]iQVRN H]HN IĘNpQW DODFVRQ\ HYLGHQFLD V]LQWĦHN YROWDN D]
pUWpNHOpVHPEHQLVDODWWLSRQWV]iPRWNDSWDN )ĘNpQWUpJHEEHQYpJ]HWWYL]VJiODWRN
voltak. (]HNNHODYL]VJiODWRNNDOD]YROWDSUREOpPDKRJ\NLVOpWV]iP~DNYROWDN
valamint vDJ\ QHP YROW NRQWUROO FVRSRUW YDJ\ FVDN HJ\ PiVLN DQWLGHSUHVV]iQV
KDWyDQ\DJKR]NpSHVWYLV]RQ\tWRWWDN(]D]pUWJRQGPLYHOLO\PyGRQQHKp]NLV]ĦUQL
D]WKRJ\D]HVHWHNKiQ\DGUpV]pEHQYROWPDJDDGHSUHVV]LyD]|QJ\LONRVViJRND
0DJDV EL]RQ\tWy HUHMĦ V]LV]WpPiV |VV]HIRJODOyN pV PHWD-anaOt]LVHN V]HULQW QLQFV

43  
 
  

NO|QEVpJVHPD]DQWLGHSUHVV]iQVRNN|]|WWVHPDSODFHERFVRSRUWKR]YLV]RQ\tWYD
D] |QJ\LONRVViJL UiWD WHNLQWHWpEHQ ( YL]VJiODWRNDW W|EE UDQGRPL]iOW NRQWUROOiOW
YL]VJiODWEHYRQiViYDOYpJH]WpNVRNEHWHJEHYRQiViYDO$*XQQHOOpVPXQNDWiUVDL
iOWDO -EHQ SXEOLNiOW PHWD-DQDOt]LV HUHGPpQ\HL V]HULQW   D] DQWLGHSUHVV]iQVRN
V]HGpVH DODWW D]   |QJ\LONRVViJRN |VV]HVtWHWW NRFNi]DWD 0,74-szerese a kontroll
FVRSRUWpQDNWHKiWDODFVRQ\DEED]|QJ\LONRVViJNRFNi]DWDD kezelt csoportban. A
QHPKDOiORV|QJ\LONRVViJLNtVpUOHWHN-V]RURVDND]DQWLGHSUHVV]iQVRNNDONH]HOW
csoportEDQ D QHP NH]HOWKH] NpSHVW (] D]W PXWDWMD XJ\DQ KRJ\ QDJ\RQ NLFVLW
PDJDVDEED]DQWLGHSUHVV]iQVWV]HGĘNN|]|WWDNRFNi]DWGHDYL]VJiODWPHJMHJ\zi,
KRJ\U|YLGYROWDN|YHWpVLLGĘ7HKiWV]iPROKDWXQND]]DODPLWD]HOĘ]ĘEHNH]GpVEHQ
UpV]OHWH]WHP KRJ\ D NH]HOpV HOHMpQ D NHOOHPHWOHQ QHP NtYiQW KDWiVRN PLDWW
IRNR]yGKDWD]|QJ\LONRVViJLNpV]WHWpV
$]DONDOPD]iVLHOĘtUiVNO|QILJ\HOPH]HWDJ\HUHNNRUUD$OHJW|EEDQWLGHSUHVV]iQV
(az SSRI-N pV D] ~MDEEDN LV HOĘtUiVD WLOWMD D PDMRU GHSUHVV]LyV J\HUHNHNQpO D
IHOKDV]QiOiVW (]W QpPLOHJ DODFVRQ\DEE V]LQWĦ GH PpJ PLQGLJ HOpJ My PLQĘVpJĦ
WDQXOPiQ\RNWiPDV]WMiNDOiD]pQSRQWR]iVLUHQGV]HUHPEHQ-13 pontot kaptak).
+iWUiQ\XN DQQ\L KRJ\ YLV]RQ\ODJ NLV EHWHJSRSXOiFLyW YL]VJiOWDN HPLDWW QĘKHW D
YpOHWOHQKLEDHVpO\H*\HUHNHNNHOVDMQRVNHYpVNOLQLNDLYL]VJiODWiOOUHQGHONH]pVUH
GHH]QHPFVDND]DQWLGHSUHVV]iQVRNUDLJD]HJ\pENpQW Ennek egyik oka, hogy nem
WHOMHVHQpUYpQ\HVOHVHWNEHQD]|QNpQWHVEHOHHJ\H]pVD]D]DV]OHLNMyYiKDJ\iVD
V]NVpJHVDYL]VJiODWEDQYDOyUpV]YpWHOKH]PtJHJ\IHOQĘWWNL]iUyODJ|QPDJDG|QW
DNH]HOpVUĘO
$IOXR[HWLQDONDOPD]iVLHOĘtUiVDQHPWLOWMDHJ\HGODPDMRUGHSUHVV]LyNH]HOpVpWD
SHGLiWULiEDQ(]HJ\EHKDQJ]LND]iOWDODPWDOiOtakkal is, tudniillik a fluoxetinnek volt
D OHJNLVHEE UHODWtY NRFNi]DWD D SODFHEyKR] NpSHVW 55  &, -2,40) [53.]
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kezelese/ PHJMHOHQtWYHMDQXiU

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appraisal. Nature Reviews Drug Discovery (2005) 4.:165-171.

[@5LKPHU=$GHSUHVV]LyNRUV]HUĦV]HPOpOHWH ± GLDJQRV]WLNDLpVWHUiSLiV
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Suicidality, Epidemiology of Depressionand Suicid,
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>@5LKPHU=)HNHWH66PHJL$gQJ\LONRVViJ

http://nol.hu/archivum/archiv-31945-20878 PHJMHOHQtWYHIHEUXiU

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460-468

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>@5iF]È1RV]iO%$KDWyDQ\DJHOWiYROtWiVDDV]HUYH]HWEĘO)O|S)1RV]iO%
6]iV]*\7DNiFVQp1RYiN.V]HUN*\yJ\V]HUpV]L.pPLD6HPPHOZHLV.LDGy
(2010) 26-46

[10.] 5LKPHU=3HVWDOLW\3$QWLGHSUHVV]tYXPRNpVKDQJXODWVWDELOL]iWRURN)UHGL-
1pPHWK$7DULVND3V]HUN$SV]LFKLiWULDPDJ\DUNp]LN|Q\YH0HGLFLQD
.|Q\YNLDGy-494

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WpQ\H]ĘN *\LUHV.OiUD)UVW=VX]VDQQDV]HUN$IDUPDNROyJLDDODSMDL0HGLFLQD
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http://www.ogyei.gov.hu/gyogyszeradatbazis/ Aurorix 150 mg, 300 mg tabletta,
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[19.] BRW]/$J\yJ\V]HUHOpVVHO|VV]HIJJĘQHPNtYiQDWRVHVHPpQ\HNBaranyai
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51  
 
  

http://www.who.int/patientsafety/events/05/Reporting_Guidelines.pdf?ua=1
PHJMHOHQtWYHDXJXV]WXV

[21.] Beard K: Introduction. Lee, A. (szerk.): Adverse Drug Reactions, London:

Pharmaceutical Press (2006) 7-8

[22.] National Coordinating Council for Medication Error Reporting and Prevention:
About medication errors: http://www.nccmerp.org/about-medication-errors
PHJMHOHQtWYHM~OLXV

[23.] Eurpean Medicines Agency: Medication errors.

http://www.ema.europa.eu/ema/index.jsp?curl=pages/special_topics/general/general_c
ontent_000570.jsp PHJMHOHQtWYH 2015. M~OLXV

[24.] *\yJ\V]HUpV]HWL pV (JpV]VpJJ\L 0LQĘVpJ pV 6]HUYH]HWIHMOHV]WpVL ,QWp]HW

Informatikai pV 5HQGV]HUHOHP]pVL )ĘLJD]JDWyViJ -RJV]DEiO\N|YHWpV
http://www.eski.hu/new3/jogszabaly/jogszabaly_teteles.php?id=390 PHJMHOHQtWYH
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[25.] Official Journal of the European Union: Directive 2010/84/EU of the European
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1/dir_2010_84/dir_2010_84_en.pdf PHJMHOHQtWYHDXJXV]WXV

[26@;&9W|UYpQ\D]HPEHULDONDOPD]iVUD NHUOĘJ\yJ\V]HUHNUĘOpVHJ\pE
J\yJ\V]HUSLDFRWV]DEiO\R]yW|UYpQ\HNPyGRVtWiViUyO†

[27.] World Health Organisation: Essential medicines and health products,

Pharmacovigilance.
http://www.who.int/medicines/areas/quality_safety/safety_efficacy/pharmvigi/en/
PHJMHOHQtWYHDXJXV]WXV

[28.] ;&9W|UYpQ\  D]HPEHULDONDOPD]iVUDNHUOĘJ\yJ\V]HUHNUĘOpVHJ\pE

J\yJ\V]HUSLDFRWV]DEiO\R]yW|UYpQ\HNPyGRVtWiViUyO†

[29.] 0DJ\DU*\yJ\V]HUpV]L.DPDUD(OQ|NVpJLWiMpNR]WDWy7iMpNR]WDWyD
IDUPDNRYLJLODQFLDIRJDOPiUyOMRJLV]DEiO\R]iViUyOpVDJ\DNRUOyJ\yJ\V]HUpV]HN

52  
 
  

V]DNPDLIHODGDWDLUyOKWWSZZZPJ\NSPKXILOHVIDUPDNRYLJLODQFLD-taj-vegl.pdf
PHJMHOHQtWYHDXJXV]WXV

[30@2UV]iJRV*\yJ\V]HUpV]HWLpVeOHOPH]pV-HJpV]VpJJ\L,QWp]HW%HMHOHQWpV
IHOWpWHOH]HWWJ\yJ\V]HU-PHOOpNKDWiVRNUyO
http://www.ogyei.gov.hu/dynamic/mellhat_bejelentolap2015_MG2.pdf PHJMHOHQtWYH
IHEUXiU

[31.] ;&9W|UYpQ\  D]HPEHULDONDOPD]iVUDNHUOĘJ\yJ\V]HUHNUĘOpVHJ\pE

J\yJ\V]HUSLDFRWV]DEiO\R]yW|UYpQ\HNPyGRVtWiViUyO†H

[32.]European Medicines Agency, Human Regulatory, Pharmacovigilance,Periodic Safety

Update Reports:
http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/docu
ment_listing_000361.jsp& PHJMHOHQtWYHDXJXV]WXV

[33.] 2UV]iJRV*\yJ\V]HUpV]HWLpVeOHOPH]pV-HJpV]VpJJ\L,QWp]HW0HOOpNKDWiVRN
EHMHOHQWpVH)RQWRVWiMpNR]WDWiVDPHOOpNKDWiV-EHMHOHQWpVUĘOpVDMHOHQWpVHN
pUWpNHOpVpQHNIRO\DPDWiUyO
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PHJMHOHQtWYHIHEUXiU

[34.] European Medicines Agency, Commitees, Pharmacovigilance Risk Assessment

Commitee.  
http://www.ema.europa.eu/ema/index.jsp?curl=pages/about_us/general/general_content
_000537.jsp PHJMHOHQtWYHIHEUXiU)

[35@$URQVRQ-.0H\OHU¶V6LGH(IIHFWVRI3V\FKLDWULF'UXJV(OVHYLHU2[IRUG
Ú2009) 77-80

[36.]  $URQVRQ-.0H\OHU¶V6LGH(IIHFWVRI3V\FKLDWULF'UXJV(OVHYLHU2[IRUG
Ú-16

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Ú-43.

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[38.] $URQVRQ-.0H\OHU¶V6LGH(IIHFWVRI3V\FKLDWULF'UXJV(OVHYLHU2[IRUG
Ú-88

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ATC/DDD Index, N06A Antidepressants:
http://www.whocc.no/atc_ddd_index/?code=N06A PHJMHOHQtWYHV]HSWHPEHU

[40@2UV]iJRV*\yJ\V]HUpV]HWLpVeOHOPH]pV-HJpV]VpJJ\L,QWp]HW
*\yJ\V]HULQIRUPiFLy*\yJ\V]HUDGDWEi]LV
http://www.ogyei.gov.hu/gyogyszeradatbazis/ PHJMHOHQtWYHV]HSWHPEHU

Melipramin 25 mg filmtabletta, TeperinEP 10 mg/25 mg/50 mg filmtabletta, Anafranil

10 mg/25 mg/ 75 mg (SR) filmtabletta, Ludiomil 10 mg/25 mg/75 mg filmtabletta,
3UR]DFPJPOEHOVĘOHJHVROGDW)HYDULQPJPJILOPWDEOHWWD=RORIWPJ
ILOPWDEOHWWDPJPONRQFHQWUiWXPEHOVĘOHJHVROGDWKR]6HUR[DWPJILOPWDEOHWWD
Cipralex 10 mg filmtabletta, Aurorix 150 mg/300 mg filmtabletta, Wellbutrin SR 150
PJUHWDUGWDEOHWWD&\PEDOWDPJJ\RPRUQHGYHOOHQiOOyWDEOHWWD7ROYRQPJ
filmtabletta, Mirtadepi 15 mg/30 mg/45 mg filmtabletta, Edronax 4 mg tabletta, Coaxil
12,5 mg bevont tabletta, Trittico AC 75 mg / 150 mg retard tabletta, Veloxan 37,5
PJPJPJUHWDUGNHPpQ\NDSV]XOD

[41.] +iEHUÈ6]ĦFV)2VYiWK3pVPWVDL$F\WRFKURP3'pV&
JHQRWtSXVLGĘV]HUĦNpUGpVHLD]DQWLGHSUHVV]tYIDUPDNRWHUiSLiEDQ*\yJ\V]HUpV]HW
Ú-734

[42.] Sackett D.L., Rosenberg W0*UD\-$pVPWVDL(YLGHQFHEDVHGPHGLFLQH

what it is and what it isn't, British Medical Journal (1996) 312: 71-72

[43@%RW]/$WXGRPiQ\RVEL]RQ\tWpNRNV]HUHSHDJ\yJ\tWiVEDQpVD
J\yJ\V]HUWHUiSLiQiO%RW]/V]HUN$J\yJ\V]HUWHUiSLDEL]RQ\tWpNRNRQpV
J\yJ\V]HUDGDWEi]LVRNRQDODSXOypUWpNHOpVpQHNJ\DNRUODWD3pFVL7XGRPiQ\HJ\HWHP
(2014) 26-28.

[44@+iEHUÈ9L]VJiODWLWtSXVRNpVHOUHQGH]pVHN0HJD-WULDOV]LV]WHPDWLNXVHOHP]pV
%RW]/V]HUN$J\yJ\V]HUWHUiSLDEL]RQ\tWpNRNRQpVJ\yJ\V]HUDGDWEi]LVRNRQ
DODSXOypUWpNHOpVpQHNJ\DNRUODWD3pFVL7XGRPiQ\HJ\HWHP-25

54  
 
  

[45.] %RW]/%L]RQ\tWpNRNRQDODSXOyJ\yJ\V]HUpUWpNHOpVV]DNPDLpVJD]GDViJL
HOHP]pVpQHN~MLVPHUHWDQ\DJDL%RW]/V]HUN$J\yJ\V]HUWHUiSLDEL]RQ\tWpNRNRQpV
J\yJ\V]HUDGDWEi]LVRNRQDODSXOypUWpNHOpVpQHNJ\DNRUODWD3pFVL7XGRPiQ\HJ\HWHP
(2014) 29-35

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The Journal of the American Medical Association (2004) 292: 338-343

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treatment and psychiatric morbidity in 390 cases of suicide with special focus on
affective disorders. Acta Psychiatrica Scandinavica (2001) 104: 458-465

[49.] 0DUWLQH]&5LHWEURFN6:LVH/pVPWVDL$QWLGHSUHVVDQWWUHDWPHQWDQGWKHULVN
of non fatal self harm in first episode depression: nested case control study. British
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[50.] ,VDFVVRQ*+ROPJUHQ3:DVVHUPDQ'pVPWVDUse of antidepressants among

people committing suicide in Sweden. British Medical Journal (1994) 308: 506-509  

[51.] JurHGLQL-1'RHFNH&-0DQVILHOG35pVPWVDLEfficacy and safety of

antidepressants for children and adolescents. British Medical Journal (2004) 328: 879-
883

[52.] .DKQ$.DKQ6.ROWV5pVPWVDSuicide rates in clinical trials of SSRIs, other

antidepressants, and placebo: analysis of FDA reports.American Journal of Psychiatry.
(2003) 160: 790-792.

[53.]  :KLWWLQJWRQ&-.HQGDOO7)RQDJ\3pVPWVDL: Selective serotonin reuptake

inhibitors in childhood depression: systematic review of published versus unpublished
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0HOOpNOHWHN

 
 
  

.|V]|QHWQ\LOYiQtWiV

(]~WRQV]HUHWQpNN|V]|QHWHWPRQGDQL WpPDYH]HWĘPQHNdr. Botz Lajosnak,

a szakdolgozatom HONpV]tWpVHVRUiQQ\~MWRWWV]DNPDL IHONpV]tWpVpUW pVWiPRJDWiVpUW

 
 
1. számú melléklet
Mellékhatások
Antidepresszánsok mellékhatásai
Cardiovaszkuláris rendszer
orthosztatikus h!hullám EKG tachycardia. vezetési palpitatio arrythmia hypertonia hypotonia perifériás hypertenzív kardiális myocardiális extrasystole mellkasi értágulat vasculitis perifériás hematuria bradycardia ventrikuláris ventrikuláris vérzés purpura
Hatóanyag csoport Hatóanyag hypotonia kipirulás eltérések zavar vazospazmus krízis dekompenzáció infarktus fájdalom ischaemia fibrilláció tachycardia

imipramin """"" """"" """"" """"" """" """" """" "" "" ""
Tri és tetraciklusos amitriptylin """" """" """" """" """" "" """ ""
antidepresszánsok clomipramin """" """" """" """" " """" """ """
maprotilin """" """" """" " """" "" " " "
fluoxetin """" """" "" """ "" ""
fluvoxaim """ """" """" #
SSRI sertralin """" # """ # """" """ "" "" #
escitalopram # # """ # # ""
paroxetin """ """ """ """ ""
MAO-A gátlók moclobemid "" """"
venlafaxin """ """" """ """" """" # # # #
duloxetin """ """" """ """" """ """" """ ""
bupropion " """" """ " """" "
reboxetin """" """" """" """" """"
Egyéb antidepresszánsok
mianszerin # # #
mirtazapin """" """
trazodon # # # # # #
tianeptin """" """" """" """" !
Jelmagyarázat
Nagyon gyakori 10 % ! !!!!!
gyakori 10%"# "1% !!!!
nem gyakori 1%" "0,1 % !!!
ritka 0,1%" "0,01 % !!
nagyon ritka 0,01 % > !
nem ismert " !
2. számú melléklet
Mellékhatások
Antidepresszánsok mellékhatásai
Pszichiátriai kórképek

hypomania álmosság rendellenes pszichózis emelkedett gondolkodási konverziós gyógyszer panaoid suicid
Hatóanyag csoport Hatóanyag delírium hallucináció dezorientáció agitatio nyugtalanság szorongás agresszió fáradékonyság álmatlanság alvászavar izgatottság fogcsikorgatás zavarodottság idegesség apathia pánikroham dadogás akathisia alvajárás
mania aluszékonyság álmok aktiválódás hangulat zavar zavar függ!ség téveszmék gondolatok

imipramin """" """" """" """" """" """" """" """" """" """" """ "" #
amitriptylin "" "" """ """ """ """" """ #
Tri és tetraciklusos antidepresszánsok
clomipramin """" """" """" """" """" """"" """" """" """"" """" """" """ #
maprotilin "" "" """" """" """" """" """" """" """" """" " "" "" #
fluoxetin "" "" """" """" """"" """" """" """" "" """ """ "" """" "" "" "" """
fluvoxamin """ "" """" """" """" """" """ """" #
SSRI sertralin """ """" """ """"" """" """" "" """ """" """" """ """ "" "" "" "" ""
escitalopram "" # """ """" """" "" """" """" """" """ """ """ """ #
paroxetin """ "" "" # """" """" """" """" """ "" "" #
MAO-A gátlók moclobemid """" """" """"" """" """/""
venlafaxin # """ "" """ # """" """" """ """" """" """ """ #
duloxetin "" """ "" """" "" """" """ """" """ """ """ """ """/""
bupropion " """" " """"" " """" """ " #
reboxetin # """" """" # """"" """" #
Egyéb antidepresszánsok
mianszerin # """" """" """" #
mirtazapin """ """ "" """" """ """" """ #
trazodon # # # # # # # # # # # # #
tianeptin # """" """" """" # """ # !
Jelmagyarázat
Nagyon gyakori 10 % ! !!!!!
gyakori 10%"# "1% !!!!
nem gyakori 1%" "0,1 % !!!
ritka 0,1%" "0,01 % !!
nagyon ritka 0,01 % > !
nem ismert " !
3. számú melléklet

Mellékhatások
Antidepresszánsok mellékhatásai
Vérképz#szervi és nyirokrendszeri

abnormális aplasztikus
Hatóanyag csoport Hatóanyag agranulocytosis leukopenia thrombocytopenia eosinophylia lymphadenopathia anaemia granulocytopenia
vérzések anaemia

imipramin !! !! !! !!
amitriptylin !! !! !! !!
Tri és tetraciklusos antidepresszánsok
clomipramin ! ! ! ! !
maprotilin ! ! ! !
fluoxetin !!
fluvoxaim
SSRI sertralin " " !!
escitalopram "
paroxetin ! !!!
MAO-A gátlók moclobemid
venlafaxin " " "
duloxetin
bupropion " " "
reboxetin
Egyéb antidepresszánsok
mianszerin " "
mirtazapin " " " " "
trazodon " " " " "
tianeptin
!

Jelmagyarázat
Nagyon gyakori 10 % ! !!!!!
gyakori 10%"# "1% !!!!
nem gyakori 1%" "0,1 % !!!
ritka 0,1%" "0,01 % !!
nagyon ritka 0,01 % > !
nem ismert " !
! !
4. számú melléklet
Mellékhatások
Antidepresszánsok mellékhatásai
Endokrin rendszer és szexuális funkció

Erektilis késleltetett menstrucáiós eml! vércukorszint hüvelyi atrophiás ejaukációs

Hatóanyag csoport Hatóanyag Libidózavar anorgasmia gynecomascia galactorrhoea SIADH hyperprolaktinaemia priapismus hyportireózis balanoposthitis herefájdalom
diszfunkció ejakuláció zavarok megnagyobbodás változás folyás vulvovaginitis fájdalom

imipramin "" "" "" ""

amitriptylin """" """" """"
Tri és tetraciklusos antidepresszánsok
clomipramin """"" """"" """" """" "
maprotilin """" " " "
fluoxetin """" """" """" "" "" "" ""
fluvoxaim """ # # "" # #
SSRI sertralin """" """"" """ # "" "" "" "" ""
escitalopram """" """" "
paroxetin """"" """"" "" "" " "" "
MAO-A gátlók moclobemid
venlafaxin """" """" """" """" """" #
duloxetin """" """" """ "" "" "" "" """
bupropion
reboxetin """" """" # """"
Egyéb antidepresszánsok
mianszerin
mirtazapin #
trazodon #
tianeptin
!

Jelmagyarázat
Nagyon gyakori 10 % ! !!!!!
gyakori 10%"# "1% !!!!
nem gyakori 1%" "0,1 % !!!
ritka 0,1%" "0,01 % !!
nagyon ritka 0,01 % > !
! ! nem ismert " !
! !
5. számú melléklet

Mellékhatások
Antidepresszánsok mellékhatásai
Anyagcsere változások

Hatóanyag csoport Hatóanyag testtömeg ! testtömeg " étvágy! étvágy" anorexia hyponatraemia hypercholesterinaemia hypoglycaemia hyperglycaemia

imipramin ##### ## ####

amitriptylin #### ## #### ##
Tri és tetraciklusos antidepresszánsok
clomipramin ##### ####
maprotilin #### #### #
fluoxetin #### ##
fluvoxaim $ $ #### $
SSRI sertralin #### #### ## ## $
escitalopram #### ### #### #### $ $
paroxetin #### ## ####
MAO-A gátlók moclobemid ## ##
venlafaxin #### $
duloxetin ### #### #### ## ## ###
bupropion ### #### # #
reboxetin #### $
Egyéb antidepresszánsok
mianszerin $
mirtazapin ##### #####
trazodon $ $ $ $
tianeptin #### $ !

Jelmagyarázat
Nagyon gyakori 10 % ! !!!!!
gyakori 10%"# "1% !!!!
nem gyakori 1%" "0,1 % !!!
ritka 0,1%" "0,01 % !!
nagyon ritka 0,01 % > !
nem ismert " ! !
6. számú melléklet
Mellékhatások
Antidepresszánsok mellékhatásai
Idegrendszeri tünetek
csökkent malignus
ízérzés epilepsziás pszichomotoros extrapiramidális serotonin egyensúly
Hatóanyag csoport Hatóanyag tremor paraesthesia fejfájás szédülés koncentráló memóriazavar fásultság convulsio ataxia myoclonus beszédzavar ájulás neuroleptikus.
zavara roham nyugtalanság tünetek syndroma zavar
képesség Szindróma
imipramin !!!!! !!!! !!!! !!!! !!! !! !! !! !!
amitriptylin !!!! !!!! !!!! !!!! !!!! !!!! !! !!!!
Tri és tetraciklusos antidepresszánsok
clomipramin !!!!! !!!! !!!!! !!!!! !!!! !!!! !!!! !!! !!! !!!!! !!!! !
maprotilin !!!!! !!!! !!!!! !!!!! !!!! ! !!!! !! ! !! !!!!! ! !
fluoxetin !!!! !!!!! !!!! !!!! !!!! !!!! !!! !!
fluvoxaim !!!! " !!!! !!!! " !! " !!! !!! " "
SSRI sertralin !!!! !!!! !!!!! !!!!! !!!! !!!! !!! !!! !!! !!!
escitalopram !!!! !!!! !!!!! !!!! !!! " " !! !! !!!
paroxetin !!!! !!!! !!!! !! !!! !
MAO-A gátlók moclobemid !!!! !!!!! !!!!!
venlafaxin !!!! !!!! !!!!! !!!!! !!! !! !!! " !!! " !!! !!! "
duloxetin !!!! !!!! !!!!! !!!! !!! !!! !!!! !! !! !! !!! !!
bupropion !!!! ! !!!!! !!!! !!!! !!!! ! !! ! !
reboxetin !!!! !!!! !!!!! !!!!
Egyéb antidepresszánsok
mianszerin " " "
mirtazapin !!!! !!! !!!!! !!!! !!!! " !!! !! " !!!
trazodon " " " " " " " " "
tianeptin !!!! !!!! !!!! " !

Jelmagyarázat
Nagyon gyakori 10 % ! !!!!!
gyakori 10%"# "1% !!!!
nem gyakori 1%" "0,1 % !!!
ritka 0,1%" "0,01 % !!
nagyon ritka 0,01 % > !
nem ismert " !
! !
7. számú melléklet

Mellékhatások
Antidepresszánsok mellékhatásai
Anyagcsere változások

Hatóanyag csoport Hatóanyag testtömeg ! testtömeg " étvágy! étvágy" anorexia hyponatraemia hypercholesterinaemia hypoglycaemia hyperglycaemia

imipramin ##### ## ####

amitriptylin #### ## #### ##
Tri és tetraciklusos antidepresszánsok
clomipramin ##### ####
maprotilin #### #### #
fluoxetin #### ##
fluvoxaim $ $ #### $
SSRI sertralin #### #### ## ## $
escitalopram #### ### #### #### $ $
paroxetin #### ## ####
MAO-A gátlók moclobemid ## ##
venlafaxin #### $
duloxetin ### #### #### ## ## ###
bupropion ### #### # #
reboxetin #### $
Egyéb antidepresszánsok
mianszerin $
mirtazapin ##### #####
trazodon $ $ $ $
tianeptin #### $ !

Jelmagyarázat
Nagyon gyakori 10 % ! !!!!!
gyakori 10%"# "1% !!!!
nem gyakori 1%" "0,1 % !!!
ritka 0,1%" "0,01 % !!
nagyon ritka 0,01 % > !
nem ismert " ! !
8. számú melléklet

Mellékhatások
Antidepresszánsok mellékhatásai
Érzékszervek

akkomodációs emelkedett
Hatóanyag csoport Hatóanyag látászavar mydriasis fülzúgás glaucoma vertigo
zavar szembelnyomás
imipramin !!!!! !!!!! !! " !!
amitriptylin !!!! !!!! !!!! !!! !!!
Tri és tetraciklusos antidepresszánsok
clomipramin !!!!! !!!!! !!!! !!!! !
maprotilin !!!! !
fluoxetin !!!! !!! !!!
fluvoxaim " "
SSRI sertralin !!!! !!! !!
escitalopram !!! !!! !!!
paroxetin !!!! !!! " !
MAO-A gátlók moclobemid !!!
venlafaxin !!!! !!!! !!!! "
duloxetin !!!! !!! !!!! !! !!!
bupropion !!!! !!!!
reboxetin !!!! !!! !! " !!!
Egyéb antidepresszánsok
mianszerin
mirtazapin
trazodon
tianeptin !

Jelmagyarázat
Nagyon gyakori 10 % ! !!!!!
gyakori 10%"# "1% !!!!
nem gyakori 1%" "0,1 % !!!
ritka 0,1%" "0,01 % !!
nagyon ritka 0,01 % > !
nem ismert " ! !
9. számú melléklet

Mellékhatások
Antidepresszánsok mellékhatásai
Vese és húgyutak
vizelettartási
Hatóanyag csoport Hatóanyag vizeletretenció vizelési zavar nehézség/gyakori
vizeletürítés
imipramin !!!!
amitriptylin !!!
Tri és tetraciklusos antidepresszánsok
clomipramin ! !!!!!
maprotilin ! !!!!
fluoxetin !! !!! !!!!
fluvoxaim !
SSRI sertralin !!! !!
escitalopram "
paroxetin !!! !!!
MAO-A gátlók moclobemid
venlafaxin !!! !!!! !!
duloxetin !!! !!!!
bupropion !
reboxetin !!!! !!!!
Egyéb antidepresszánsok
mianszerin
mirtazapin "
trazodon
tianeptin !

Jelmagyarázat
Nagyon gyakori 10 % ! !!!!!
gyakori 10%"# "1% !!!!
nem gyakori 1%" "0,1 % !!!
ritka 0,1%" "0,01 % !!
nagyon ritka 0,01 % > !
nem ismert " ! !
10. számú melléklet

Mellékhatások
Antidepresszánsok mellékhatásai
B!r és b!r alatti szövetek

hideg erythema steven-johnson toxikus epidermális

Hatóanyag csoport Hatóanyag izzadás b!rkiütés urticaria fényérzékenység ödéma pruritus hajhullás
verejték multiform syndróma necrosis
imipramin """"" """" """" "" "" "" ""
amitriptylin """" """ """ "" """ ""
Tri és tetraciklusos antidepresszánsok
clomipramin """"" """" """" """"
maprotilin """" """" """" """" " " " "
fluoxetin """" """" """" "" """ """
fluvoxaim """" """ "" """ """
SSRI sertralin """" """" """ # """ """ """ """ # #
escitalopram """" """ """ # """ """
paroxetin """" """ " " " " "
MAO-A gátlók moclobemid """" """ """
venlafaxin """"" """ # """ """ # """ # # #
duloxetin """" """" """ """ "" """ ""
bupropion """" """" " "
reboxetin """"" """"
Egyéb antidepresszánsok
mianszerin #
mirtazapin """" # # #
trazodon # # #
tianeptin """ """ """ !

Jelmagyarázat
Nagyon gyakori 10 % ! !!!!!
gyakori 10%"# "1% !!!!
nem gyakori 1%" "0,1 % !!!
ritka 0,1%" "0,01 % !!
nagyon ritka 0,01 % > !
nem ismert " !