Benzodiazepin-Abhängigkeit: Ursachen und Behandlungsmöglichkeiten

Zusammenfassung

Benzodiazepine werden wegen ihrer schnell einsetzenden anxiolytischen, sedativen und Schlaf anstoßenden Wirkungen sehr häufig verordnet. Längere Einnahme ist jedoch mit der Entwicklung einer Abhängigkeit assoziiert. Neben der Entwicklung einer körperlichen Abhängigkeit, die sich im Falle einer Therapieunterbrechung durch ein typisches Benzodiazepin-Entzugssyndrom äußert, scheint die schnell einsetzende anxiolytische und beruhigende Wirkung der Benzodiazepine auch die psychische Abhängigkeitsentwicklung zu begünstigen. Auf neurobiologischer Ebene verstärken Benzodiazepine durch Bindung an den GABA_A-Rezeptor die GABA gesteuerte Neurotransmission. Kompensatorische, gegenregulatorische Prozesse wie die Verstärkung der glutamatergen Neurotransmission werden mit der Entstehung der typischen Entzugssymptomatik in Zusammenhang gebracht. Zudem scheint die Benzodiazepintherapie auch die Expression von Neuropeptiden wie Corticotropin Releasing Hormon und Neuropeptid Y zu beeinflussen. Die genauen neurobiologischen Ursachen der Abhängigkeitsentwicklung sind jedoch unklar. Da auch die langfristige Einnahme niedriger Benzodiazepindosen mit Nebenwirkungen wie der Beeinträchtigung der Kognition verbunden ist, sollte in jedem Fall ein Benzodiazepin-Entzug angestrebt werden. Sowohl Antikonvulsiva als auch Antidepressiva scheinen sich auf die Entzugssymptomatik und Langzeitprognose der Benzodiazepinabhängigkeit günstig auszuwirken.

Abstract

Benzodiazepines are very often prescribed because of their anxiolytic, sedative and hypnotic properties. However, long term treatment is associated with development of benzodiazepine dependence. Besides development of physical dependence, which is linked to a typical benzodiazepine withdrawal syndrome when drug intake is discontinued, also behavioural addiction to benzodiazepines has been described. Benzodiazepines are known to enhance GABAergic neurotransmission. Counter regulation of enhanced GABAergic neurotransmission by enhancement of glutamatergic neurotransmission is thought to be one reason underlying the typical symptoms of benzodiazepine withdrawal. Also alterations in the expression of neuropeptides like Corticotropin Releasing Hormone and Neuropeptide Y are thought to be involved in the development of benzodiazepine dependence. However, until today the knowledge of neural mechanisms underlying the development of benzodiazepine dependence remains incomplete. Because even long term treatment with small doses of benzodiazepines is associated with adverse reactions like cognitive dysfunctions withdrawal from benzodiazepines should be aimed. Anticonvulsants and antidepressants seem to reduce the intensity of benzodiazepine withdrawal and to enhance long term prognosis of dependence.

Schlüsselwörter

Benzodiazepinabhängigkeit - Benzodiazepin-Entzug - neuroendokrinologische Veränderungen

Key words

benzodiazepine dependence - benzodiazepine withdrawal - neurobiological mechanisms

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