Aktuelle Pharmakotherapie der Depression

Zusammenfassung

Antidepressiva sind die mit Abstand am häufigsten verordneten Psychopharmaka, derzeit sind 26 Substanzen in Deutschland verfügbar. Diese lassen sich nach Wirkmechanismus und Selektivität einteilen. Die Indikationsstellung bedarf einer sorgfältigen Abwägung, obligat sind Voruntersuchungen sowie spätere Kontrolluntersuchungen. Die Auswahl erfolgt vor allem nach Verträglichkeit bzw. zu erwartenden unerwünschten Arzneimittelwirkungen sowie nach dem dominierenden klinischen Bild. Es lassen sich unterschiedliche Wirkprofile hinsichtlich Schlaf, Sedierung/ Aktivierung, Schmerz-, Zwangs- und Angstsymptomatik unterscheiden. Die Wirksamkeit von Antidepressiva ist für die Akuttherapie und Rezidivprophylaxe gut belegt, allerdings kommt es bei ca. 30% der Patienten zu “Therapieresistenz”. Hier sind spezielle Interventionen erforderlich (z. B. Augmentation mit Lithium, Kombinationstherapien). Als Sonderformen an klinischer Bedeutung gewonnen haben die Parkinson-Depression, die Poststroke-Depression und Depressionen bei anderen somatischen Erkrankungen (KHK, Myokardinfarkt, COPD).

Summary

Antidepressants are the most frequently prescribed psychotropics in Germany. They can be classified and selected according mechanisms of action, pharmacological selectivity, tolerability and side effects. Clinical profiles comprise different effects on sleep, sedation, psychomotor activity, pain, anxiety, cognition and obsessive-compulsive symptoms. Efficacy of antidepressants is well established for acute treatment and relapse prevention, however, about 30% of patients remain “therapy-resistant” making special interventions (e.g. lithium augmentation) necessary. Increasingly important is the comorbid treatment of patients with Parkinson’s disease, cardiovascular disorders, tumours and post-stroke-depression.

Schlüsselwörter

Antidepressiva - Depressionstherapie - Pharmakotherapie

Keywords

Antidepressants - depression - pharmacological treatment

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