Pharmakologische Kombinationsbehandlung bipolarer Störungen

Zusammenfassung

Die Behandlung der bipolaren Störung hat in den letzten Jahren einen Wandel erfahren: Bei leichten Verläufen von manischen und depressiven Episoden sind immer noch monotherapeutische Ansätze zielführend, wobei zunehmend häufiger neben den „klassischen” Medikamenten wie Lithium, Valproinsäure und Carbamazepin auch atypische Antipsychotika (AAP) eingesetzt werden. Für die Therapie der manischen Episode sind derzeit die meisten verfügbaren AAP zugelassen, und auch für die Rückfallprophylaxe und die Behandlung der depressiven Episode existieren bereits Zulassungen. Bei mittelschweren und schweren depressiven oder manischen Episoden werden zunehmend Kombinationen eingesetzt, da sie in der Regel schneller wirken und teilweise auch besser verträglich sind. In einer Vielzahl von Studien konnte die Überlegenheit der Kombinationsbehandlung im Gegensatz zu verschiedenen, etablierten Monotherapien gezeigt werden. Dieser Übersichtsartikel fasst die vorhandenen Studien und Ergebnisse mit Fokus auf die Kombinationsbehandlung zusammen, um aktuelle medikamentöse Therapieempfehlungen für eine effektive Behandlung der bipolaren Störung zu geben.

Abstract

In the course of time, the treatment regime of bipolar disorder has changed: in mild cases of manic and depressive episodes, monotherapeutic approaches are still commonly used. Besides the use of the common agents like lithium, valproatic acid and carbamazepine, other agents such as atypical antipsychotics (AAP) are used more frequently. For the therapy of manic episodes, most of the usual AAP are approved; some of them are or will be approved in the near future even for the continuation therapy and for depressive episodes. For moderate and severe courses of depressive or manic episodes, combination therapy strategies are used more often. Combination strategies seem to be more effective than monotherapeutic treatments, because of faster effects and better tolerance. In a lot of studies, these positive effects and advantages in contrast to monotherapeutic treatments could be proven. In this review article, studies and results with the focus on combination therapy will be summarised to recommend the ”state-of-the-art”-treatment for bipolar disorder.

Schlüsselwörter

bipolare Störung - Kombinationsbehandlung - Pharmakotherapie - Antipsychotika - Stimmungsstabilisierer

Key words

bipolar disorder - combination therapy - pharmacotherapy - antipsychotics - mood stabilizer

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