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Dopaminagonisten als Antidepressiva

Experimentelle und klinische Befunde

Antidepressant effects of dopamine agonists

Experimental and clinical findings

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Zusammenfassung

Neurobiologische Befunde und die Mechanismen antidepressiv wirksamer Substanzen lassen darauf schließen, dass neben serotonergen und noradrenergen Mechanismen das dopaminerge System eine wichtige Rolle in der Pathogenese und Behandlung depressiver Störungen spielt. Experimentelle, präklinische Studien geben Hinweise auf die Beteiligung des dopaminergen Systems in der Entwicklung von Angst, Depression und Anhedonie. So wirken neuere Antidepressiva wie Bupropion, Sertralin und Venlafaxin partiell als Inhibitoren der präsynaptischen Dopaminaufnahme. Bei den neueren, nichtergolinen Dopaminagonisten wurden in experimentellen Studien für Ropinirol anxiolytische und für Pramipexol neben anxiolytischen auch antidepressive und antianhedone Effekte nachgewiesen, wofür spezifische Effekte an D2-/D3-Rezeptoren im mesolimbischen System und präfrontalen Kortex verantwortlich gemacht werden. Untersuchungen bei Patienten mit Morbus Parkinson und Depression zeigen, dass Pramipexol und Pergolid antidepressive Wirkungen haben, wobei Pramipexol neben der Reduktion motorischer Symptome auch eine deutliche Verbesserung von Anhedonie bewirkt. Ein interessantes neues Indikationsgebiet ist der Einsatz von Dopaminagonisten bei Patienten mit Depressionen als Add-on-Medikation in der Kombination mit Antidepressiva und Stimmungsstabilisatoren, wofür erste kontrollierte Studien vorliegen.v

Summary

Results of preclinical and clinical studies implicate that, in addition to serotonin and norepinephrin, dopaminergic mechanisms play a role in the pathogenesis and treatment of depression. Newer antidepressants such as bupropion, sertraline, and venlafaxine act as partial inhibitors of presynaptic dopamine reuptake. Experimental studies show that dopaminergic effects contribute to the development of anxiety, depression, and anhedonia. These studies revealed, among the new nonergot dopamine agonists, anxiolytic properties for ropinirole and anxiolytic, antidepressive, and antianhedonic effects of pramipexole which seem to relate to its specific action on D2 and D3 receptors in the mesolimbic system and prefrontal cortex. In addition, affective disorders may be associated with impairments of neuronal plasticity, and pramipexole seems to exert neurotrophic properties. Controlled and open studies in depressed patients with Parkinson’s disease show therapeutic effects of dopamine agonists on motor deficits, anhedonia, and depression. Various dopamine agonists have been tested in open studies in patients with depression and may add to the spectrum of treatment options in mood disorders. Recently published placebo-controlled trials in small patient groups implicate that pramipexole is effective as additional treatment to mood stabilizers in I and II bipolar depression.

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  1. Rheinische Kliniken Bonn, Kaiser-Karl-Ring 20, 53111, Bonn, Deutschland

    M. R. Lemke

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Lemke, M.R. Dopaminagonisten als Antidepressiva. Nervenarzt 78, 31–38 (2007). https://doi.org/10.1007/s00115-006-2104-0

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