Tesis

Pengaruh Fluoxetine terhadap Peningkatan Kadar Nitric Oxide Penderita Depresi Pasca Sindrom Koroner Akut = The Influence of Fluoxetine in Nitric Oxide level in Patients with Post Acute Coronary Syndrome Depression.

Latar Belakang. Depresi sering terjadi pada penderita sindroma koroner akut (SKA) dan berhubungan dengan peningkatan mortalitas penderita SKA. Obat selective serotonin reuptake inhibitor (SSRI) telah diketahui efikasinya pada depresi pasca SKA. Nitric oxide (NO) merupakan salah satu penanda fungsi endotel. Studi menunjukkan kemampuan SSRI citalopram dalam memperbaiki fungsi endotel melalui peningkatan kadar nitric oxide (NO). Fluoxetine merupakan obat SSRI yang tersedia dengan baik di Indonesia belum pernah diteliti pengaruhnya pada peningkatan kadar NO. Tujuan. Mengetahui pengaruh pemberian fluoxetine 20 mg/hari selama 8 minggu terhadap peningkatan kadar NO pasien depresi pasca SKA, serta Mengetahui korelasi antara perbaikan simtom depresi dengan peningkatan kadar NO pasien depresi pasca SKA yang mendapatkan fluoxetine 20 mg/hari selama 8 minggu. Metode. Penelitian uji klinik tersamar acak ganda yang dilakukan pada JanuariSeptember 2015 di poklinik Jantung RSUP Dr.Sardjito Yogyakarta. Subjek adalah penderita pasca SKA usia 40-60 tahun yang memenuhi kriteria depresi. Subjek dirandomisasi untuk mendapatkan fluoxetine dosis 20 mg/hari selama 8 minggu atau plasebo. Simtom depresi yang diukur dengan kuesioner BDI dan kadar NO diambil pada awal dan akhir minggu ke 8 penelitian. Hasil. Dari 44 subjek yang mengikuti penelitian, 24 subjek mendapatkan fluoxetine dan 20 subjek mendapatkan plasebo. Analisis dilakukan pada 19 subjek kelompok fluoxetine dan 19 subjek kelompok plasebo. Rerata kadar NO sebelum dan sesudah pemberian fluoxetine adalah berturut-turut 31,86(2,4) μm dan 29,7(2,7) μm. Rerata kadar NO sebelum dan sesudah pemberian plasebo adalah berturut-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; p 0,215). Simpulan. Fluoxetine dosis 20 mg/hari selama 8 minggu pada pasien depresi pasca SKA tidak meningkatkan kadar NO. Penurunan skor BDI pasien depresi pasca SKA yang mendapatkan fluoxetine 20 mg/hari selama 8 minggu tidak berkorelasi dengan peningkatan kadar NO.
Kata kunci: fluoxetine, depresi pasca SKA, nitric oxide.



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 for depression in post ACS patients. Nitric oxide (NO) was a well known marker of endothelial function. Study on SSRI Citalopram showed an increasing level of NO after administration of citalopram. Fluoxetine was available in Indonesia, but its function in improving endothelial function through the increasing of NO level remains unknown. Purpose. To evaluate the influence of fluoxetine 20 mg daily for 8 weeks in increasing NO level in patients post ACS with depression, and to evaluate the correlation between improvement in depressive symptoms and increment of NO level in post ACS depression patients who receive fluoxetine 20 mg daily for 8 weeks. Method. It was a randomized double blind clinical trial counducted in JanuarySeptember

2015 whic held in Sardjito General Hospital Yogyakarta. Eligible subjects were post ACS age 40-60 years who fulfilled depression criteria. Subjects were randomized to receive fluoxetine 20 mg daily or plasebo for 8 weeks. Depressive symtoms were evaluate using BDI inventory. Nitric oxide level were taken at baseline and the end of week 8. Results. From 44 subjects, 24 subjects received fluoxetine, while 20 subjectcs received placebo. Analysis was done in 19 subjects of fluoxetine group and 19 subjects of plasebo group. Means of NO level before and after treatment in fluoxetine group were 31,86(2,4) μm and 29,7(2,7) μm respectively. We found no correlation between improvement of depressive symptoms and increment of NO level (r -0,206; p 0,215). Conclusions. The NO level was not increased in post ACS depression patients who recieve fluoxetine 20 mg daily for 8 weeks. The improvement of depressive symptoms was not correlated with increment of NO level in post ACS patients depression patients who recieve fluoxetine 20 mg daily for 8 weeks.
Keywords: fluoxetine, post ACS depression, nitric oxide.