Wie lassen sich monoaminerge, antidepressive Therapien verbessern?

Zusammenfassung

Monoamin-basierende antidepressive Substanzen, die selektiv auf den Serotonin-/Noradrenalin- und auch auf die Dopamin-Wiederaufnahme wirken, sind hochwirksam. Allerdings gibt es immer noch eine relativ große Anzahl Patienten, die auf diese Substanzen nicht ausreichend ansprechen. Hinzukommt, dass durch die Wirklatenz von mindestens zwei Wochen wertvolle Behandlungszeit verloren geht. Eine Erhöhung der Effektivität selektiv wirksamer Antidepressiva kann durch Augmentationsstrategien erreicht werden. Außerdem gibt es neuere Antidepressiva, die einen dualen Wirkmechanismus aufweisen, und damit sowohl die serotonerge als auch die noradrenerge Transmission erhöhen. Die Überlegenheit eines dualen Wirkprinzips wird durch eine Reihe klinischer Studien belegt. In diesem Beitrag sollen die Lithium-, die Pindolol- und die Schilddrüsenhormonaugmentation antidepressiver Therapien sowie die beiden Antidepressiva mit dualem Wirkmechanismus, Venlafaxin und Duloxetin, vorgestellt werden.

Summary

Monoaminergic antidepressants that selectively target serotonin-, norepinephrine- or dopamin reuptake are highly effective. There is, however, a significant number of patients that does not or only partially respond to these medications. The 2-week latency of onset is an additional limitation of the uselfulness of these drugs. An increased effectiveness of monoaminergic antidepressants can be achieved by implementing augmentation strategies or by using dual-mechanism antidepressants that target the serotonergic and the noradrenergic transmission. The supremacy of a dual antidepressant mechanism over a selective one is supported by a number of recent studies. In this article, lithium- pindolol- and thyroid-hormone augmentation and the dual-mechanism antidepressants venlafaxine and duloxetine are discussed.

Key Words

depression - antidepressants - venlafaxine - duloxetine

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