ABSTRAK
Latar Belakang. Depresi sering terjadi pada penderita sindroma koroner akut(SKA) dan berhubungan dengan peningkatan mortalitas penderita SKA. Obatselective serotonin reuptake inhibitor (SSRI) telah diketahui efikasinya padadepresi pasca SKA. Nitric oxide (NO) merupakan salah satu penanda fungsiendotel. Studi menunjukkan kemampuan SSRI citalopram dalam memperbaikifungsi endotel melalui peningkatan kadar nitric oxide (NO). Fluoxetinemerupakan obat SSRI yang tersedia dengan baik di Indonesia belum pernahditeliti pengaruhnya pada peningkatan kadar NO.Tujuan. Mengetahui pengaruh pemberian fluoxetine 20 mg/hari selama 8 mingguterhadap peningkatan kadar NO pasien depresi pasca SKA, serta Mengetahuikorelasi antara perbaikan simtom depresi dengan peningkatan kadar NO pasiendepresi pasca SKA yang mendapatkan fluoxetine 20 mg/hari selama 8 minggu.Metode. Penelitian uji klinik tersamar acak ganda yang dilakukan pada JanuariSeptember2015dipoklinikJantungRSUPDr.SardjitoYogyakarta.Subjekadalahpenderitapasca SKA usia 40-60 tahun yang memenuhi kriteria depresi. Subjekdirandomisasi untuk mendapatkan fluoxetine dosis 20 mg/hari selama 8 mingguatau plasebo. Simtom depresi yang diukur dengan kuesioner BDI dan kadar NOdiambil pada awal dan akhir minggu ke 8 penelitian. Hasil. Dari 44 subjek yang mengikuti penelitian, 24 subjek mendapatkanfluoxetine dan 20 subjek mendapatkan plasebo. Analisis dilakukan pada 19 subjekkelompok fluoxetine dan 19 subjek kelompok plasebo. Rerata kadar NO sebelumdan sesudah pemberian fluoxetine adalah berturut-turut 31,86(2,4) μm dan29,7(2,7) μm. Rerata kadar NO sebelum dan sesudah pemberian plasebo adalahberturut-turut 32,44(2,48) μm dan 30,09(2,87) μm. Tidak terdapat korelasi antara perbaikan simtom depresi dan peningkatan kadar NO pada pasien depresi pasca SKA yang mendapatkan fluoxetine dibandingkan kelompok plasebo (r -0,206; p0,215).Simpulan. Fluoxetine dosis 20 mg/hari selama 8 minggu pada pasien depresipasca SKA tidak meningkatkan kadar NO. Penurunan skor BDI pasien depresipasca SKA yang mendapatkan fluoxetine 20 mg/hari selama 8 minggu tidak berkorelasi dengan peningkatan kadar NO.
ABSTRACT
Background. Depression was prevalent in post acute coronary syndrome (ACS)patients and this condition was related with increasing morbidity and mortality.selective serotonin reuptake inhibitor has established as a treatment choice fordepression in post ACS patients. Nitric oxide (NO) was a well known marker ofendothelial function. Study on SSRI Citalopram showed an increasing level of NOafter administration of citalopram. Fluoxetine was available in Indonesia, but itsfunction in improving endothelial function through the increasing of NO levelremains unknown.Purpose. To evaluate the influence of fluoxetine 20 mg daily for 8 weeks inincreasing NO level in patients post ACS with depression, and to evaluate thecorrelation between improvement in depressive symptoms and increment of NOlevel in post ACS depression patients who receive fluoxetine 20 mg daily for 8weeks.Method. It was a randomized double blind clinical trial counducted in JanuarySeptember2015 whic held in Sardjito General Hospital Yogyakarta. Eligiblesubjects were post ACS age 40-60 years who fulfilled depression criteria. Subjectswere randomized to receive fluoxetine 20 mg daily or plasebo for 8 weeks. Depressive symtoms were evaluate using BDI inventory. Nitric oxide level weretaken at baseline and the end of week 8.Results. From 44 subjects, 24 subjects received fluoxetine, while 20 subjectcsreceived placebo. Analysis was done in 19 subjects of fluoxetine group and 19subjects of plasebo group. Means of NO level before and after treatment influoxetine group were 31,86(2,4) μm and 29,7(2,7) μm respectively. We found nocorrelation between improvement of depressive symptoms and increment of NOlevel (r -0,206; p 0,215).Conclusions. The NO level was not increased in post ACS depression patientswho recieve fluoxetine 20 mg daily for 8 weeks. The improvement of depressivesymptoms was not correlated with increment of NO level in post ACS patients depression patients who recieve fluoxetine 20 mg daily for 8 weeks. |
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