Zusammenfassung
In den beiden letzten Jahren ist die Diskussion der Frage, ob Antidepressiva, insbesondere selektive Serotoninwiederaufnahmehemmer (SSRIs), zu Suizidalität, Aggressivität und Gewaltbereitschaft führen können, wieder neu aufgeflammt. Hier soll die aktuelle Datenlage zu der Problematik, die seit Einführung dieser Substanzgruppe Ende der 1980er Jahre diskutiert wird, dargestellt werden. Nach systematischer Literaturrecherche kommen wir zu dem Schluss, dass ein wissenschaftlicher Konsens darüber besteht, dass der Nutzen der antidepressiven Pharmakotherapie im Allgemeinen und der Therapie mit SSRIs und selektiven Serotonin-/Noradrenalinwiederaufnahmehemmern (SSNRIs) im Besonderen die Risiken ihrer Anwendung überwiegt. Dies gilt auch für die Behandlung von Kindern, Jugendlichen und jungen Erwachsenen. Die zu Behandlungsbeginn gelegentlich auftretende Unruhe kann bei entsprechend disponierten Patienten in seltenen Fällen als so aversiv erlebt werden, dass Suizidgedanken oder -handlungen verstärkt oder sogar ausgelöst werden. Hierauf ist insbesondere zu Behandlungsbeginn zu achten. Wir empfehlen, dass die Indikation für die antidepressive Pharmakotherapie von Kindern, Jugendlichen und jungen Erwachsenen von einem Facharzt gestellt wird.
Summary
In the last 2 years the discussions on the question whether antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) can lead to suicidality, aggression and violence, flared up again. The available data on the problem, which has been discussed since the introduction of this substance group in the late 1980s, is presented in this article. A systematic literature search showed that a scientific consensus exists that the benefits of antidepressant pharmacotherapy in general, and of treatment with SSRIs and selective serotonin/norepinephrine reuptake inhibitors (SSNRIs) in particular, outweigh the risks of their use. This also applies to the treatment of children, adolescents and young adults. The agitation occasionally occurring at the beginning of treatment, which can be experienced as aversive in susceptible patients, can intensify or even trigger suicidal thoughts or impulses. This has to be paid particular attention to especially at the beginning of treatment. It is recommended that the indications for antidepressant pharmacotherapy of children, adolescents and young adults are assessed by a specialist.
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Einhaltung ethischer Richtlinien
Interessenkonflikt. G. Gründer war in den letzten 2 Jahren bzw. ist gegenwärtig als Berater der folgenden Firmen tätig: Cheplapharm (Greifswald, Deutschland), Eli Lilly (Indianapolis, Ind, USA), Lundbeck (Kopenhagen, Dänemark), Roche (Basel, Schweiz), Servier (Paris, Frankreich) und Takeda (Osaka, Japan). Er war als Sprecher tätig für die folgenden Firmen: Eli Lilly, Gedeon Richter (Budapest, Ungarn), Janssen-Cilag (Neuss, Deutschland), Roche und Servier. Er hat Mittel für die Durchführung von Forschungsprojekten von folgenden Firmen erhalten: Alkermes, Boehringer-Ingelheim (Ingelheim, Deutschland), Eli Lilly und Roche. Er ist Mitbegründer der Firmen Pharma-Image – Molecular Imaging Technologies GmbH, Düsseldorf, und Brainfoods UG, Düsseldorf. Die beiden anderen Autoren erklären, kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.
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Gründer, G., Veselinović, T. & Paulzen, M. Antidepressiva und Suizidalität. Nervenarzt 85, 1108–1116 (2014). https://doi.org/10.1007/s00115-014-4092-9
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DOI: https://doi.org/10.1007/s00115-014-4092-9