Missbrauch und Abhängigkeit von Benzodiazepinen und Z-Drugs

Michael Soyka

doi:10.1055/a-1523-5718

Nervenheilkunde, Table of Contents

Nervenheilkunde 2021; 40(08): 636-647
DOI: 10.1055/a-1523-5718

Schwerpunkt

Missbrauch und Abhängigkeit von Benzodiazepinen und Z-Drugs

Klinik und Therapie

Michael Soyka∗

¹Psychiatrische klinik München, Universitäts München

› Author Affiliations

Abstract

ZUSAMMENFASSUNG

Missbrauch und Abhängigkeit von Sedativa und Hypnotika sind klinisch häufig (Prävalenz ca. 2%), insbesondere von Benzodiazepinen und Non-Benzodiazepin-Hypnotika (Z-Drugs). Beide Substanzgruppen haben ältere und weit toxischere Sedativa und Hypnotika wie Barbiturate und Meprobamat zu Recht verdrängt. Benzodiazepine wie Z-Drugs entfalten ihre Wirkung über den inhibitorischen GABA-Rezeptor und können beide eine erhebliche Toleranz induzieren, was klinisch zu Dosissteigerungen, physischer und psychischer Abhängigkeit, Kontrollverlust sowie Entzugssymptomen führen kann. Prädisponierende Faktoren sind neben dem Geschlecht, Frauen sind häufiger betroffen, vor allem psychiatrische und psychosomatische Erkrankungen, insbesondere Angst und Schlafstörungen, aber auch psychosomatische Störungen und chronische Schmerzerkrankungen. Besonders häufig und lange werden Benzodiazepine älteren Patienten verschrieben, entgegen aller Leitlinienempfehlungen.

Therapeutisch gesichert ist, dass bei Benzodiazepinabhängig-keit ein langsames Ausschleichen über viele Wochen, manchmal sogar Monate notwendig ist. Ansonsten können erhebliche Entzugserscheinungen inklusive epileptischen Anfällen, Psychosen und Delire auftreten. Das Entzugssyndrom bei Sedativa und Hypnotika ist sehr vielgestaltig mit Depression, Agitation, innerer Unruhe und Perzeptions-und Schlafstörungen als häufigen Symptomen. Die übrige Therapie ist pragmatisch und richtet sich nach den zugrunde liegenden psychischen Störungen und Entzugssymptomen. Im Wesentlichen werden Antidepressiva eingesetzt. Kurzzeitinterventionen werden empfohlen. Psychotherapeutisch haben sich Psychoedukation, kognitive Verhaltenstherapie oder motivationale Therapien bewährt.

Full Text

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