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Der Nervenarzt

, Volume 83, Issue 8, pp 1006–1012 | Cite as

Transkranielle und invasive Hirnstimulationsverfahren bei Depression

  • C. PlewniaEmail author
  • F. Padberg
Leitthema

Zusammenfassung

Aufgrund des erheblichen Anteils depressiver Patienten, der nicht ausreichend auf pharmakologische und psychotherapeutische Maßnahmen reagiert, besteht starkes Interesse an neuen Behandlungsstrategien. Aktuell steht ein ganzes Spektrum von Hirnstimulationsverfahren zur Verfügung, die für die antidepressive Behandlung infrage kommen. Darunter sind konvulsive und nichtkonvulsive transkranielle (Elektrokonvulsionstherapie [EKT], Magnetkonvulsionstherapie [MKT], transkranielle Magnetstimulation [TMS], transkranielle Gleichstromstimulation [tDCS]) sowie invasive Verfahren (tiefe Hirnstimulation [THS], Vagusnervstimulation [VNS], epidurale kortikale Stimulation [ECS]). Jede Methode repräsentiert einen spezifischen Ansatz zur Modulation depressionsassoziierter neuronaler Aktivität. Die EKT hat sich seit langem als bislang effektivstes Verfahren bewährt. Die Behandlung mit TMS erreicht das höchste Evidenzniveau unter den neuen antidepressiven Hirnstimulationsverfahren und wird bereits klinisch eingesetzt. Aufgrund des rasant wachsenden Wissens zur Pathophysiologie depressiver Störungen werden Hirnstimulationsverfahren mit hoher Wahrscheinlichkeit das Spektrum antidepressiver Therapiemethoden in naher Zukunft wesentlich erweitern.

Schlüsselwörter

Hirnstimulation Depression Affektive Störungen Therapie Therapieresistente Depression 

Transcranial and invasive brain stimulation for depression

Summary

Considering the substantial proportion of depressed patients which does not sufficiently benefit from antidepressant pharmacotherapy or psychotherapy, there is increasing interest in non-pharmacological antidepressant strategies. Thus, a whole array of stimulation approaches has been developed as potential new antidepressant interventions. These methods include transcranial convulsive and non-convulsive approaches, e.g. electroconvulsive therapy (ECT), magnetic seizure therapy (MST), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) as well as invasive techniques, e.g. deep brain stimulation (DBS), vagus nerve stimulation (VNS) and epidural cortical stimulation (ECS). Each method represents a specific therapeutic approach with distinct targets within neural networks involved in the pathophysiology of depression. The ECT procedure is an established treatment with the highest efficacy of all antidepressant interventions and TMS reaches the highest level of evidence among the novel neurostimulation approaches and may be clinically used. However, the field yields a promising rapid development which may substantially enrich the armamentarium of antidepressant interventions in the near future.

Keywords

Brain stimulation Depression Mood disorders Therapy Treatment-resistant depression 

Notes

Interessenkonflikt

Der korrespondierende Autor weist für sich und seinen Koautor auf folgende Beziehungen hin: C. Plewnia erhält Unterstützung für Forschungsprojekte von inomed Medizintechnik, Emmendingen. F. Padberg erhält Unterstützung für Forschungsprojekte von neuroConn GmbH, Ilmenau und Brainsway Inc., Jerusalem.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Universitätsklinik für Psychiatrie und Psychotherapie, Abteilung für allgemeine Psychiatrie und Psychotherapie mit PoliklinikEberhard Karls Universität TübingenTübingenDeutschland
  2. 2.Klinik für Psychiatrie und PsychotherapieLudwig-Maximilians-Universität MünchenMünchenDeutschland

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