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Zusammenfassung

Bei Untersuchungen von Strukturvarianten bekannter Neuroleptika wurden vor über 40 Jahren die antidepressiven Wirkungen von Imipramin entdeckt. Mit der überzeugenden Wirksamkeit des Imipramin und seinen Analogen — den trizyklischen Antidepressiva — wurde eine neue Ära in der medikamentösen Behandlung der Depression eingeläutet. Alle trizyklischen Antidepressiva hemmen die Wiederaufnahme von Neurotransmittern, insbesondere von den biogenen Aminen Serotonin, Noradrenalin und Dopa-min. Ihre anticholinerge Wirkung ist therapeutisch unerwünscht und verursacht typische Nebenwirkungen wie Mundtrockenheit, verschwommenes Sehen und Harnverhalten. Bald danach wurden die Monoaminoxidase-Inhibitoren entdeckt, die durch Hemmung des Abbauenzyms der biogenen Amine eine vergleichbare Wirkung erzielten. Die zufällige Beobachtung der stimmungsaufhellenden Wirkung des Tuberkulosemedikaments Iproniazid in den frühen 50er Jahren und die Bestätigung der Wirkung bei depressiven Patienten führte zu der Erkenntnis, daß eine Nebenwirkung — die Hemmung der Monoaminoxidase — ein neues Prinzip zur Behandlung der Depression darstelle. Diese beiden Substanzklassen bildeten über viele Jahre die Standardtherapie der Depression. Hauptproblem sind die zum Teil schweren kardiotoxischen Nebenwirkungen, wobei etwa nach Suizidversuchen die Herzrhythmusstörungen schwer in den Griff zu bekommen sind.

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Literatur

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© Steinkopff Verlag, Darmstadt 1999

Authors and Affiliations

  1. 1.Klinik für PsychiatrieAllgemeines KrankenhausWienÖsterreich

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