Medikamentöse Therapie der ADHS im Erwachsenenalter

Zusammenfassung

Medikamentöse Therapie der ersten Wahl bei Erwachsenen mit ADHS ist die orale Gabe von Stimulanzien, in erster Linie Methylphenidat. Diese Medikation hat sich über viele Jahre bewährt und ist als ausgesprochen nebenwirkungsarm anzusehen. Die Titrierung muss langsam einschleichend individuell erfolgen, Dosierungen über 40 mg sind nur selten erforderlich. In den letzten Jahren stehen neu entwickelte Retardpräparationen zur Verfügung, die eine tägliche Einmalgabe ermöglichen. Etwa ein Drittel der Patienten spricht nicht ausreichend auf Methylphenidat an; in diesen Fällen ist die Gabe von Amphetamin oder dual wirksamen Antidepressiva sinnvoll. Der spezifische Noradrenalin-Wiederaufnahmehemmer Atomoxetin beeinflusst im Frontalhirn nicht nur die Noradrenalin-, sondern auch die Dopamin-Konzentrationen. Häufig ist bei Erwachsenen mit ADHS, die vielfach unter komorbiden psychiatrischen Störungen leiden, eine medikamentöse Kombinationstherapie angezeigt.

Summary

Treatment with stimulants is the pharmaceutical therapy of first choice in ADHD of adulthood. Methylphenidate is mainly used. This medication is established over a lot of years and no severe side effects are seen. The titration has to take place individually slowly; the effective daily dose seldom exceeds 40 mg. Extended release formulations of stimulants were developed in the last years, they are effective with an intake of only one dose daily. One third of the patients do not respond to a medication with methylphenidate, these patients may profit from a change to treatment with amphetamines or dual active antidepressants. The norepinephrine reuptake inhibitor atomoxetine influences not only norepinephrine but also dopamine concentration. Comorbidities are often occurring in adults with ADHD, therefore a combined treatment of stimulants with other substances regarding the comorbid disorder is useful.

Key Words

ADHD - stimulants - methylphenidate - atomoxetine

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