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Monoaminerge Funktion bei depressiven Patienten

Eine Hilfe bei der Wahl der Behandlungsstrategie?

Monoaminergic function in major depression

A possibly helpful tool for choosing treatment strategy

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Zusammenfassung

Über Parameter, welche eine Vorhersage des Behandlungserfolgs bei depressiven Störungen ermöglichen, ist bisher wenig bekannt. Die meisten Studien implizierten keine klinische Konsequenz für die Behandlung, da die untersuchten Prädiktoren unspezifisch waren und die Ergebnisse nicht zwischen verschiedenen Therapieoptionen unterschieden. Könnten jedoch spezifische Prädiktoren gefunden werden, die eine Vorhersage der für den einzelnen Patienten individuell optimalen Therapieoption ermöglichen, könnte die erhebliche Anzahl von Nonrespondern reduziert werden. Da die meisten antidepressiven Medikamente auf das serotonerge oder noradrenerge System wirken, stellt der Status der monoaminergen Funktion zu Behandlungsbeginn potenziell einen möglicherweise spezifischen Prädiktor eines Therapieerfolgs dar. Im Folgenden werden Verfahren zur Bestimmung monoaminerger Funktion und deren Zusammenhang zum antidepressiven Behandlungserfolg dargestellt, u. a. Monoaminabbauprodukte, neuroendokrine Stimulationstests, evozierte ereigniskorrelierte Potenziale, Genetik und Bildgebung. Insgesamt zeigt sich, dass die Befunde zu serotonergen Funktionen gegenwärtig noch nicht einheitlich sind, vor allem jedoch der Zusammenhang zwischen noradrenerger Funktion und Therapieresponse für eine Beurteilung bisher zu wenig untersucht wurde.

Summary

Little is known about the variables that might predict outcome in major depression. Most studies do not imply any clinical consequences for treatment because their predictors were nonspecific and results did not differ between the different treatment options. Finding a variable that can predict the antidepressive treatment option best suited to an individual might help in reducing the considerable number of nonresponders in the treatment of depression. As most antidepressants influence the serotonergic or noradrenergic system, monoaminergic function at the start of therapy might be a possible specific response predictor. In this review, measures that can determine monoaminergic function are presented along with their relationship to treatment response, e.g., monoaminergic metabolites, neuroendocrine challenge tests, evoked event-related potentials, genetics, and neuroimaging. In conclusion, the results of serotonergic functions are still heterogenous, but the relationship between noradrenergic function and treatment response has not been investigated in any detail yet.

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Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum der RWTH Aachen

    O. Moeller, C. Norra & G. Gründer

  2. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    O. Moeller

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  1. O. Moeller
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  2. C. Norra
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Correspondence to O. Moeller.

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Moeller, O., Norra, C. & Gründer, G. Monoaminerge Funktion bei depressiven Patienten. Nervenarzt 77, 800–808 (2006). https://doi.org/10.1007/s00115-005-2042-2

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