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Psychopharmaka zur Behandlung suizidaler Patienten und zur Suizidprävention

Psychopharmaceuticals for treatment of suicidal patients and for suicide prevention

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Zusammenfassung

Die Behandlung suizidaler Patienten stellt ein häufiges, zumeist akutpsychiatrisches Problem dar. Vor dem Hintergrund der Häufigkeit dieses Phänomens imponiert die aktuelle Datenlage zu suizidverhindernden Wirkeffekten von Psychopharmaka insgesamt unzureichend und enttäuschend. Mit Ausnahme von Lithium und Clozapin ist eine suizidverhindernde Wirkung von Psychopharmaka nicht belegt, ja nach bislang vorliegenden Studien unwahrscheinlich. Nach wie vor fehlen zum einen kontrollierte, randomisierte Studien, zum anderen limitieren ethische und methodische Probleme die klinische Forschung auf diesem Gebiet, was insbesondere an der aktuellen Datenlage zu den immer wieder behaupteten suizidpräventiven Wirkeffekten von Antidepressiva deutlich wird. Im Rahmen der Akutbehandlung ist unter Antidepressiva eine Reduktion der depressiven Störung zugeordneten Suizidgedanken möglich, jedoch muss die ebenfalls mögliche suizidprovozierende Wirkung insbesondere der neueren Antidepressiva gleichzeitig berücksichtigt werden. Der zeitnahen symptomatischen Behandlung psychomotorischer Erregung und Ängstlichkeit muss in Form einer sedierenden Pharmakotherapie mit Benzodiazepinen oder niedrig-potenten Neuroleptika höchste Bedeutung beigemessen werden. Im Rahmen der Erhaltungstherapie sollten Patienten vor dem Hintergrund der aktuellen Datenlage nach stattgehabten Suizidversuchen oder chronischer Suizidalität im Rahmen bipolarer oder unipolarer affektiver Erkrankungen von den positiven Effekten einer Behandlung mit Lithium und im Rahmen psychotischer Erkrankungen einer Behandlung mit Clozapin möglichst überzeugt werden.

Abstract

Suicidality represents a frequent phenomenon in affective and psychotic disorders but the treatment of acute and chronic suicidality is still a controversial issue. Especially the efficacy of antidepressant and neuroleptic drugs for prevention of suicide continues to be debated. There is a lack of evidence due to limitations of methodological studies and ethical concerns are a major issue. Considering methodological problems in the conducted studies the often insufficiently valued differentiation between suicidal thoughts and actual suicidal behavior has to be emphasized. With the exception of lithium and clozapine suicide-preventing effects of antidepressants and neuroleptics could not yet be demonstrated. Regarding new antidepressant drugs, such as selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) even the possible new onset of suicidal thoughts and ideations as an adverse effect needs to be stressed. Considering the frequent occurrence of suicidality the currently available evidence is undoubtedly insufficient. The improvement of study concepts and especially a more differentiated consideration of the vague term “suicidality” seems to be essential. An underrepresentation of the evidence-based therapeutic options with lithium and clozapine in the treatment of suicidal patients needs to be avoided.

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Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    R. Haußmann, M. Bauer & U. Lewitzka

  2. Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Deutschland

    B. Müller-Oerlinghausen

Authors
  1. R. Haußmann
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  2. M. Bauer
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  3. U. Lewitzka
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  4. B. Müller-Oerlinghausen
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Corresponding author

Correspondence to R. Haußmann.

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Interessenkonflikt

R. Haußmann und B. Müller-Oerlinghausen geben an, dass kein Interessenkonflikt besteht.

U. Lewitzka: Forschungszuwendungen von BMBF, AFSP (USA), Dalhousie University Halifax (Kanada), Gulinsky Stiftung sowie Vortragshonorare von AstraZeneca, Lundbeck und Lilly.

M. Bauer: Forschungszuwendungen: DFG, BMBF, AFSP. Beratertätigkeit: Ferrer Internacional, Novartis, Janssen, Lilly, Lundbeck, Otsuka, Servier, Takeda. Vortragshonorare: AstraZeneca, Pfizer, Lilly, Lundbeck, Otsuka, Servier.

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Haußmann, R., Bauer, M., Lewitzka, U. et al. Psychopharmaka zur Behandlung suizidaler Patienten und zur Suizidprävention. Nervenarzt 87, 483–487 (2016). https://doi.org/10.1007/s00115-016-0088-y

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