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Antikonvulsiva

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Akute und therapieresistente Depressionen

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Zusammenfassung

Bisher haben sich die drei Antikonvulsiva Carbamazepin, Valproat und Lamotrigin bei der Behandlung affektiver Erkrankungen bewährt. Antikonvulsiva sind vor dem Hintergrund einiger gemeinsamer pathophysiologischer Veränderungen in der Epilepsie und bei der Depression eine Behandlungsalternative von klinischem und wissenschaftlichem Interesse. In der Behandlung unipolarer therapieresistenter Depressionen kommen dabei vor allem Augmentationsstrategien zum Einsatz.

Die bisher veröffentlichten Studien haben deutliche Einschränkungen: Es existieren kaum placebokontrollierte Studien, die Fallzahlen sind in den meisten Fällen sehr gering, und in vielen älteren Studien wurde nicht zwischen unipolarer und bipolarer Depression unterschieden.

Bei der Behandlung therapieresistenter Depressionen (TRD) sollte immer geprüft werden, ob möglicherweise eine bipolare Depression vorliegt. Ungefähr 30–40% aller TRD sind dem bipolaren Spektrum zuzuordnen. Bei der Behandlung bipolarer TRD steht die augmentative Behandlung mit Lithium, Schilddrüsenhormonen oder einem Antikonvulsivum an erster Stelle. Sind sämtliche etablierten Therapieregime wie z. B. die Lithiumaugmentation zu unipolaren TRD ausgereizt, so ist auch hier eine Augmentation mit einem Antikonvulsivum zu erwägen. Nach bisheriger Datenlage sollte man dabei als erstes eine Augmentation mit Carbamazepin in Dosen von 100–400 mg versuchen.

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Authors
  1. F. Seemüller
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  2. H. Grunze
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Editors and Affiliations

  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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Seemüller, F., Grunze, H. (2005). Antikonvulsiva. In: Bauer, M., Berghöfer, A., Adli, M. (eds) Akute und therapieresistente Depressionen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-28049-9_21

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  • DOI: https://doi.org/10.1007/3-540-28049-9_21

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-40617-4

  • Online ISBN: 978-3-540-28049-1

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