Zusammenfassung
Antikonvulsiva wie Carbamazepin und Valproat werden erfolgreich in der Behandlung
der Manien und zur Prophylaxe affektiver und schizoaffektiver Erkrankungen eingesetzt.
Auch Oxcarbazepin, ein Ketoderivat des Carbamazepins, zeigte sich bereits in den frühen
80er-Jahren bei diesen Erkrankungen als antimanisch wirksam. Im Vergleich zu Carbamazepin
weist Oxcarbazepin zudem eine bessere Verträglichkeit auf. Trotz dieses Vorteils fand
Oxcarbazepin jedoch bei der Behandlung psychiatrischer Erkrankungen kaum Beachtung.
In diesem Beitrag werden die bisherigen Studien zur Behandlung affektiver und schizoaffektiver
Psychosen mit Oxcarbazepin dargestellt und zusammenfassend bewertet: Oxcarbazepin
scheint in der Behandlung akuter Manien effektiv zu sein und bei adjuvanter Therapie
affektiver und schizoaffektiver Störungen eine Reduzierung der notwendigen Neuroleptikadosis
bei gleicher klinischer Wirkung zu erlauben. Außerdem weist Oxcarbazepin durch eine
deutlich geringere Interaktion mit dem Cytochrom-P450-System eine bessere Verträglichkeit
bei der in der Pharmakopsychiatrie oft üblichen Kombinationsbehandlung auf. Die Befunde
sprechen dafür, dass im Rahmen größerer Studien die antimanische Wirkung von Oxcarbazepin
validiert und weitere mögliche pharmakopsychiatrische Indikationsgebiete evaluiert
werden sollten.
Abstract
The therapeutic value of anticonvulsants in affective and schizoaffective disorders
was documented in several clinical trials. Oxcarbazepine (OXC), a keto-derivative
of carbamazepine, which appears to have a preferable side effect profile compared
to carbamazepine, has also shown antimanic efficacy in affective and schizoaffective
disorders in clinical studies since the early 80's, but was not further investigated
regarding these indications. Therefore, the value of OXC in the treatment of affective
and schizoaffective disorders requires evaluation. Literature was reviewed with regard
to pharmacokinetic and pharmacodynamic characteristics of OXC, drug-drug interactions
relevant in pharmacopsychiatry, and clinical effects in these disorders. According
to the literature OXC is regarded effective in acute mania and appears to allow reduction
of the neuroleptic medication required for the treatment of affective and schizoaffective
disorders. In addition, it has a preferable pharmacokinetic profile with less severe
side effects compared to other anticonvulsants and neuroleptics. Furthermore, it appears
to be well tolerated if augmented to neuroleptics or antidepressants, since OXC does
not interact substantially with the cytochrome P450-enzyme-system. However, despite
promising effects of OXC, few clinical studies have been published in the last 16
years. We conclude that further studies should validate the antimanic efficacy of
OXC and evaluate possible pharmacopsychiatric indications as well as limitations of
this psychotropic compound.
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Priv.-Doz. Dr. D. E. Dietrich
Abteilung Klinische Psychiatrie und Psychotherapie · Medizinische Hochschule Hannover
30623 Hannover
eMail: dietrich.detlef@mh-hannover.de
