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Lithiumaugmentation

Conference paper

Zusammenfassung

  1. 1.

    Unter Lithiumaugmentation versteht man die Hinzugabe von Lithium zu einem Antidepressivum in der Akuttherapie depressiver Patienten nach Non-Response auf eine antidepressive Monotherapie.

     
  2. 2.

    Seit der Erstbeschreibung von de Montigny 1981 wurde die Lithiumaugmentation bis heute in ca. 30 prospektiven Studien bei etwa-500 depres siven Patienten untersucht. Die Wirksamkeit dieses Verfahrens wurde mit allen gängigen Antidepressiva-Substanzklassen überprüft (u.a. Trizyklika, SSRIs, MAO-Hemmer). Eine Meta-Analyse der Plazebo-kon trollierten Doppelblindstudien zeigte, daß die Zugabe von Lithium zum Antidepressivum signifikant wirksamer als Plazebo ist.

     
  3. 3.

    Nach einer raschen Aufdosierung (1. Tag: 12 mmol, ab 2. Tag 18 – 24 mmol) sollte ein Lithium-Serumspiegel von 0.5 – 0.8 mmol/1 nach der ersten Behandlungswoche angestrebt werden.

     
  4. 4.

    Etwa 50 – 60% der therapieresistenten depressiven Patienten respon-dieren auf die Lithiumzugabe innerhalb von 2 – 6 Wochen. Bei ca. einem Fünftel der Responder kommt es bereits innerhalb der ersten zwei bis vier Tage nach Lithiumzugabe zu einer klinisch relevanten Symptomreduktion bis hin zur Vollremission. Das Verfahren besitzt deshalb einen hohen Stellenwert in der Behandlung therapierefraktärer Patienten.

     
  5. 5.

    Aufgrund der guten Verträglichkeit kann die Lithiumaugmentation auch bei älteren Patienten empfohlen werden, wobei lediglich der verminderten Clearance durch etwas niedrigere Lithium-Serumspiegel (0.4 – 0.6 mmol/1) Rechnung getragen werden sollte.

     

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© Springer-Verlag Berlin Heidelberg 1997

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