Associação entre uso de antidepressivos, condição periodontal e marcadores inflamatórios locais

Abstract

Antidepressants are drugs used to treat depression, anxiety and other psychiatric disorders. Some antidepressants, such as selective serotonin reuptake inhibitors (SSRI), have anti- inflammatory and immunomodulatory activities demonstrated in vitro/in vivo, with reduced expression of inflammatory markers in gingival tissue (including pro-inflammatory cytokines) and resorption alveolar bone. The use of some antidepressants has been associated with improvements in periodontal clinical parameters in humans, although the relationship between clinical findings and inflammatory markers has not yet been investigated. Thus, the objective of this thesis was to evaluate the association between the use of antidepressants, periodontal condition and local inflammatory markers. In Chapter 1, a systematic review was developed evaluating the impact of the use of antidepressants on inflammatory/clinical parameters related to periodontal conditions in animals and humans. After a systematic search in selected bibliographic databases, twelve studies were selected. In vivo studies observed that fluoxetine (SSRI), tianeptine, desipramine and imipramine reduced alveolar bone loss in models of periodontitis induced in rats. Fluoxetine, desipramine and imipramine also reduced the expression/activity of inflammatory markers in the animals' gingival tissue. In humans, observational studies have found an association between the use of fluoxetine and lower probing depths or loss of clinical attachment. The use of desvenlafaxine was associated with shallower probing depth and less bleeding on probing, while the use of venlafaxine did not influence periodontal clinical parameters in humans. Furthermore, the SSRI class or the concomitant use of multiple classes of antidepressants have been associated with improvements in clinical parameters in humans. In Chapter 2, a cross-sectional clinical study was carried out investigating the association between the use of SSRIs and changes in the levels of inflammatory markers and oxidative stress related to periodontitis in drug users, correlating the findings with periodontal clinical parameters. Forty-two patients were divided into three groups: 1) short-term (N=12) – patients treated with SSRI for up to six months; 2) long term (N=20) – patients treated with SSRIs for more than six months; 3) non-user (N=10) – patients with indication for use who had not started treatment. Unstimulated saliva was collected to determine salivary flow and concentrations of IL-1β, IL-6, IL-10, IL-17, NO and H2O2. Clinical periodontal parameters evaluated included visible plaque index, bleeding index on probing, probing depth and clinical attachment level. Data obtained were evaluated using univariate and multivariate analyses, of correlation between clinical/laboratory parameters and principal components (PCA) (significance level: 5%). There was no difference between the groups regarding the severity of the periodontal condition. There was no difference between the groups regarding the severity of the periodontal condition, nor regarding salivary flow. The long-term group had lower levels of IL-10 compared to the other groups and a higher IL-1β/IL-10 ratio compared to the short-term group (P<0.05). IL-1β showed a greater number of correlations with clinical parameters. The duration of SSRI use was associated with a reduction in IL-17 and IL-10 levels and an increase in the IL-1β/IL-10 ratio (P<0.05). The PCA showed differences between user and non-user groups. Considering both chapters of this thesis, it was concluded that the use of antidepressants may be associated with the inflammatory response and clinical parameters in the periodontium and that the use of SSRIs may influence salivary inflammatory markers that correlate with periodontal parameters in humans.