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Pharmakotherapie der Depression bei Menschen mit Diabetes

Pharmacotherapy for depression in diabetics

  • Leitthema
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Der Diabetologe Aims and scope

Zusammenfassung

Der Zusammenhang zwischen psychischen Erkrankungen, vor allem der majoren Depression, und Typ-2-Diabetes wird durch viele Einzeluntersuchungen und Metaanalysen bestätigt. Das komorbide Auftreten von Depression und Diabetes beeinflusst sowohl die Prognose als auch das therapeutische Ergebnis beider Erkrankungen. Beispielsweise sind diabetestypische Komplikationen bei Patienten mit komorbider Depression häufiger als bei Diabetespatienten ohne Depression.

Für die tägliche Praxis sind zwei Fragen entscheidend: Wie lässt sich eine komorbide Depression diagnostizieren? und: Welche Therapie ist unter Beachtung der spezifischen Stoffwechsellage diabeteskranker Patienten angezeigt? Obwohl die Depression eine klinische Diagnose ist, lässt sich die diagnostische Sicherheit mit erprobten Screening-Verfahren verbessern. Zur Therapie werden neben Psychoedukation, Psychotherapie und lebensstilverändernden Interventionen auch antidepressiv wirksame Medikamente eingesetzt. Diese unterscheiden sich in ihrem Nebenwirkungsspektrum. Die Strategie der antidepressiven Behandlung bei Patienten mit komorbider Depression und Diabetes sollte sich daher nicht nur an der antidepressiven Wirksamkeit, sondern auch an der metabolischen Verträglichkeit orientieren.

Abstract

A number of epidemiological studies and meta-analyses support the finding of an association between major depressive disorder (MDD) and type 2 diabetes mellitus type 2 (T2DM). Comorbidity of MDD with T2DM worsens the course of both diseases. In particular, T2DM patients comorbid with MDD have higher rates of micro- and macroangiopathic complications including diabetic retinopathy and diabetic neuropathy.

Two important questions have to be answered by the clinician: How is comorbid depression diagnosed, and which antidepressant treatment should be chosen against the background of the specific metabolic aspects to be borne in mind in diabetics? Although depression is a clinical diagnosis, proven screening methods can strengthen diagnostic certainty. In general, MDD comorbid with T2DM is treated multimodally, including psychoeducation, psychotherapy, lifestyle-changing interventions and antidepressant pharmacotherapy, all with varying side effects. Since the efficiency of antidepressant pharmacotherapy is similar between the available medicaments, selection should be made according to the side-effect profile of the specific substance and the requirements of the patients with T2DM.

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Authors and Affiliations

  1. Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    K.G. Kahl, S. Lampen-Inkamp, K. Göllner, J. Liersch, B. Claassen, A. Wilkening, G. Schik & T. Peschel

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  1. K.G. Kahl
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  2. S. Lampen-Inkamp
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  3. K. Göllner
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  4. J. Liersch
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  5. B. Claassen
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  6. A. Wilkening
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  7. G. Schik
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  8. T. Peschel
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Correspondence to K.G. Kahl.

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Kahl, K., Lampen-Inkamp, S., Göllner, K. et al. Pharmakotherapie der Depression bei Menschen mit Diabetes. Diabetologe 6, 280–286 (2010). https://doi.org/10.1007/s11428-009-0534-6

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  • DOI: https://doi.org/10.1007/s11428-009-0534-6

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