Kombination von Antidepressiva

Zusammenfassung

In der Praxis werden Kombinationen von Antidepressiva zur Behandlung von Depressionen eingesetzt, die auf eine adäquate Monotherapie keine Remission erreicht haben und zur Behandlung von unerwünschten Nebenwirkungen, die unter einer Monotherapie aufgetreten sind. Zu den zum Teil sehr komplexen Kombinationstherapien gibt es noch zu wenig randomisierte kontrollierte Studien, sodass die klinisch-praktische Entscheidung häufig auf Erfahrungswissen, Fallberichten, unkontrollierten Studien und auf Überlegungen zur Pharmakodynamik und -kinetik der Substanzen basiert. Im vorliegenden Artikel erfolgt getrennt für die Indikationen eine systematische Zusammenfassung und Evidenzbewertung der wissenschaftlichen Datenlage zu den möglichen Kombinationen von Antidepressiva. Für die Indikation “Non-Remission” unter Monotherapie haben die Kombinationen eines selektiven Serotoninrückaufnahmeinhibitors (SSRI) mit α2-Antagonisten, Bupropion und Desipramin den höchsten Evidenzgrad und können empfohlen werden. Für die Indikation “UAW” unter Antidepressivamonotherapie kann die Zugabe von Bupropion zu SSRI/ SSNRI bei antidopaminergen Nebenwirkungen und die Gabe von α2-Antagonisten zu SSRI bei Schlafund sexuellen Störungen empfohlen werden.

Summary

In clinical practice combinations of antidepressants are used for the treatment of patients with depression, who did not experience remission after monotherapy or for the treatment of side effects caused by antidepressant medication. Only few randomized controlled trials were performed for combination therapies; therefore, decisions are often based on clinical experience, case reports, open label studies and considerations of pharmacodynamics and -kinetics. The following article presents separated for indications a systematic summary and an evaluation of scientific evidence for possible combinations of antidepressants. For “non-remission” under monotherapy, the combinations of SSRI with α2-antagonists, bupropion and desipramine can be advised due to AHPCR-criteria. For the indication “side effects due to antidepressant monotherapy” the addition of buproprion to SSRI/SSNRI can be recommended to overcome antidopaminergic side-effects and α2-antagonists added to SSRI for sleeping disorders and sexual malfunctions.

Schlüsselwörter

Antidepressiva - Kombinationstherapie - Depression - Remission - unerwünschte Arzneimittelnebenwirkungen

Keywords

Antidepressants - combination therapy - depression - remission - side effects

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