Augmentationsstrategien bei Therapieresistenz auf Antidepressiva

Zusammenfassung

Anliegen Die folgende Arbeit fasst Nutzen und Risiko der bisher bekannten Augmentationstherapien bei therapieresistenten Depressionen zusammen. Methode Die Literaturauswahl erfolgte mittels einer Medline-Datenbankrecherche der Jahrgänge 1990 - 2004. Ergebnisse Unter den Augmentationsstrategien ist die Wirksamkeit der Lithium- und - mit Einschränkungen - auch der T3-Augmentation am besten dokumentiert. Augmentationsstrategien mit atypischen Antipsychotika, Buspiron, Modafinil und dopaminergen Substanzen sind überlegenswerte, jedoch eher nachgeordnete Behandlungsalternativen. Schlussfolgerung Die detaillierte Kenntnis der dargestellten Augmentationsstrategien ermöglicht bessere Behandlungsergebnisse bei therapieresistenten Depressionen.

Abstract

Objective Various pharmacological strategies have been developed to treat such refractory depression, of which augmentation therapies are one of the most important. This article reviews both benefits and risks of all known augmentation therapies. Methods The relevant literature was identified by means of a computerized MEDLINE research on the years 1990 - 2004 and scanning of review articles. Results The efficacy of lithium augmentation is very well documented by a large number of controlled studies - lithium augmentation can therefore be recommended in depression refractory to antidepressant treatment. T3 augmentation is - in contrast to lithium augmentation - only a second-line strategy. There is an increasing number of augmentation therapies with atypical antipsychotics - its efficacy already supported by some well designed placebo controlled studies. Augmentation strategies with buspirone, modafinil and dopaminergic agents show good results in some case series and open studies, but there is a lack of doubleblind placebo controlled studies till now. Other augmentation therapies with stimulants, reserpine, pindolol, SAME and Yohimbine are very interesting clinical research strategies with rather little impact on clinical practice at the moment. Conclusions The distinct knowledge of available augmentation strategies may help to increase response - as well as remission rates in therapy resistant depression.

Schlüsselwörter

Therapieresistente Depression - Augmentationsstrategien - Antidepressiva-Nonresponse

Key words

therapy resistant depression - refractory depression - augmentation strategies

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