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Antidepressive Pharmakotherapie

Bei leichter und schwerer Erkrankung, bei jung und alt

Antidepressive pharmacotherapy

In slight and severe disease, young and old

  • Arzneimitteltherapie
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Zusammenfassung

Während der letzten Dekade wurden vielversprechende neue Substanzen und Therapieprinzipien in die Pharmakotherapie depressiver Störungen eingeführt, die nicht nur die serotonerge und noradrenerge Neurotransmission verstärken, sondern ebenso das Dopamin- oder das Melatoninsystem beeinflussen. Trotz irreführender Diskussion in Fach- und Laienpresse ist die klinische Wirksamkeit antidepressiver Pharmakotherapien nach wie vor unumstritten. Die Hauptvorteile neuer Substanzen bestehen in der Erweiterung des Behandlungsspektrums und der besseren Verträglichkeit im Vergleich zu älteren Präparaten. Vor allem mittel- bis schwergradige Depressionen sollten pharmakotherapeutisch behandelt werden. Bei besonders schweren Depressionen können dual wirksame Substanzen überlegen sein. Bei Kindern ist eine gute Wirksamkeit für Ω3-Fettsäuren, bei Jugendlichen für SSRI belegt. Ältere Patienten sprechen auf alle antidepressiven Wirkmechanismen an, wobei aus Gründen der besseren Verträglichkeit selektivere Substanzen bevorzugt werden sollten. Die Erforschung neuer Behandlungsmöglichkeiten ist von höchster Wichtigkeit, um in Zukunft bessere klinische Strategien in der Behandlung depressiver Erkrankungen gewährleisten zu können. Dies ist zudem von herausragender sozioökonomischer Bedeutung.

Abstract

During the past decade a variety of promising new compounds launched onto the market not only enhancing serotonergic and noradrenergic neurotransmission, but also influencing the dopamine and the melatonergic receptor system. In spite of misleading discussions both in the specialized and in the lay press the clinical effectiveness of antidepressants still is indisputable. The main advantages of the newer drugs are the broadening of the spectrum treatments and a far better tolerability profile in comparison to older compounds. Predominantly depression of medium to high severity should be treated pharmacologically. Especially severe depression seems to respond better to dually acting antidepressants. In children effectiveness of Ω3-fatty acids has been shown, in adolescents SSRI treatment was efficacious. Older patients respond to all antidepressant mechanisms, but more selective substances should be preferred due to a better tolerability. The study of new treatment options is of major importance to provide better strategies for the clinical management of depression in the future, and is thus also of great socio-economic importance.

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Abb. 1

Abbreviations

DNRI:

Dopamin- und Noradrenalinwiederaufnahmehemmer

MAOI:

Monoaminooxidasehemmer

NARI:

Noradrenalinwiederaufnahmehemmer

NaSSA:

Noradrenerg und spezifisch serotonerge Antidepressiva

NNT:

„number needed to treat“

RIMA:

Reversible Monoaminooxidasehemmer

SNRI:

Serotonin- und Noradrenalinwiederaufnahmehemmer

SSRI:

Selektive Serotoninwiederaufnahmehemmer

TCA:

Trizyklische Antidepressiva

UAW:

Unerwünschte Arzneimittelwirkungen

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin:

Referententätigkeit für die Firmen Astra Zeneca, Servier, Jannsen und Wyeth in den letzten 3 Jahren.

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Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, Nußbaumstraße 7, 80336, München, Deutschland

    T.C. Baghai & H.J. Möller

  2. Klinik für Psychiatrie, Psychotherapie und psychosomatische Medizin, Schloss Werneck, Werneck, Deutschland

    H.P. Volz

Authors
  1. T.C. Baghai
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  2. H.P. Volz
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  3. H.J. Möller
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Correspondence to T.C. Baghai.

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Baghai, T., Volz, H. & Möller, H. Antidepressive Pharmakotherapie. Internist 50, 235–243 (2009). https://doi.org/10.1007/s00108-009-2320-3

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