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Therapieresistenz unter Antidepressiva: Definition, Epidemiologie und Risikofaktoren

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Zusammenfassung

  1. 1.

    Etwa ein Drittel der depressiven Patienten spricht auf eine Vierwöchige Behandlung mit Antidepressiva nicht an. Die Suche nach den Gründen für Therapieresistenz gegenüber antidepressiver Behandlung, die Erfassung ihrer Häufigkeit und die Evaluation sinnvoller Therapiestrategien werden u.a. durch uneinheitliche Definitionen von Response/Non-Response erschwert. Auch besteht keine Einigkeit, nach wie vielen bzw. nach welchen erfolglos gebliebenen Behandlungsversuchen das Vorliegen einer Therapieresistenz festgestellt werden muß.

     
  2. 2.

    Als klinisch-pragmatische Definition von Therapieresistenz gilt fehlende Response auf wenigstens zwei Antidepressiva mit unterschiedlichen Wirkungsschwerpunkten bei ausreichender Dosierung und Therapiedauer (mindestens 150 mg eines Trizyklikums über 4 – 6 Wochen).

     
  3. 3.

    Zahlreiche Studien, die anamnestische und psychopathologische Merkmale sowie biologische Faktoren (wie Metaboliten von depressionsrelevanten Transmittern, Aktivität von Enzymen, die am Transmitterstoffwechsel beteiligt sind, neuroendokrinologische und neurophysiologische Parameter) auf ihre prognostische Aussagekraft in Beziehung zu Erfolg/Nichterfolg einer Antidepressivabehandlung untersuchten, lieferten bisher sehr widersprüchliche Ergebnisse.

     
  4. 4.

    Als relevante Merkmale für schlechteres Ansprechen auf Antidepressiva gelten schlechte soziale Adaptation, neurotische Züge der Primärpersönlichkeit, Nichtansprechen auf frühere Behandlungen mit Antidepressiva, Chronifizierung der depressiven Symptomatik, schwache Ausprägung der depressiven Symptomatik, Wahnideen, Fehlen von Vitalstörungen und unzureichende Besserung in den ersten 10–20 Tagen der Antidepressiva-Behandlung.

     

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