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Augmentationsbehandlung mit Lithium

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Book cover Akute und therapieresistente Depressionen

Zusammenfassung

Unter Lithiumaugmentation versteht man die Addition von Lithium zu einem Antidepressivum in der Akuttherapie depressiver Episoden bei Nichtansprechen auf eine Antidepressiva-Monotherapie. Dieses Verfahren ist bezüglich seiner Wirksamkeit die wissenschaftlich am besten belegte pharmakologische Behandlungsstrategie bei therapieresistenten Depressionen. In einer Metaanalyse von 9 doppelblinden, placebokontrollierten Studien wurde die Wirksamkeit der Lithiumaugmentation bestätigt. Die Lithiumaugmentation gilt daher in internationalen Leitlinien und antidepressiven Stufenplänen als das Vorgehen der ersten Wahl bei Nichtansprechen auf Antidepressiva. Nach rascher Aufdosierung sollten Lithiumspiegel angestrebt werden, wie sie auch für die prophylaktische Behandlung etabliert sind (0,6–0,8 mmol/l). Eine placebokontrollierte Studie zur Wirksamkeit der Lithiumaugmentation in der Erhaltungstherapie zeigte, dass im Falle einer Response die Lithium-Antidepressivum-Kombination für mindestens 12 Monate fortgeführt werden sollte. Als Wirkmechanismus wird eine Stimulierung der serotonergen Neurotransmission diskutiert. Neue Untersuchungen zeigen darüber hinaus einen aktivierenden Einfluss auf die Hypothalamus-Hypophysen-Nebennieren-Achse (HPA-Achse) und damit einen Effekt, der im Gegensatz zu dem steht, was unter einer Behandlung mit einem trizyklischen Antidepressivum beobachtet wurde.

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  1. M. Bauer
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  2. M. Trendelenburg
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  3. T. Bschor
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  1. Klinik für Psychatrie und Psychotherapie, Charité — Universitätsklinik Berlin, Campus Charité Mitte (CCM), Schumannstr. 20/21, 10117, Berlin

    Michael Bauer  & Mazda Adli  & 

  2. Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité — Universitätsklinik Berlin, Campus Charité Mitte (CCM), Luisenstr. 57, 10117, Berlin

    Anne Berghöfer

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Bauer, M., Trendelenburg, M., Bschor, T. (2005). Augmentationsbehandlung mit Lithium. In: Bauer, M., Berghöfer, A., Adli, M. (eds) Akute und therapieresistente Depressionen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-28049-9_18

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