Update zur Dosis-Wirkungsbeziehung antidepressiver Psychopharmakotherapie mit SSRI

Zusammenfassung

Selektive Serotoninwiederaufnahmehemmer (SSRI) sind bei der pharmakologischen Therapie zahlreicher psychischer Störungen sehr wichtig. Bei der Behandlung depressiver Störungen mit SSRI zeigte die Evidenz eine flache Dosis-Wirkungsbeziehung. Ergebnisse einer Metaanalyse von Jakubovski et al. zeigen, dass die Dosis-Wirkungsbeziehung von SSRI bei der Behandlung depressiver Störungen positiv sein könnte. Der Übersichtsartikel stellt die Metaanalyse von Jakubovski et al. dar und diskutiert die Ergebnisse im Kontext vorangehender Metaanalysen.

Summary

Selective serotonin reuptake inhibitors (SSRI) are essential in the pharmacotherapy of multiple psychiatric disorders. Previous evidence showed a flat dose response curve of SSRI in the treatment of depressive disorders. Results of a meta-analysis published by Jakubovski et al. indicate that the dose-response relationship of SSRI in the treatment of depressive disorders may be positive. This review article presents the meta-analysis of Jakubovski et al. and discusses these findings in conjunction with previous studies.

Schlüsselwörter

SSRI - Dosis-Wirkungsbeziehung - Metaanalyse - Depression

Keywords

SSRI - dose-response relation - meta-analysis - depression

• Literatur

• 1 Fritze J. et al. Psychopharmaka-Verordnungen: Ergebnisse und Kommentare zum Arzneiverordnungs-Report 2012. Psychopharmakotherapie 2012; 20 (02) 67-81.
• 2 Adli M. et al. Is dose escalation of antidepressants a rational strategy after a medium-dose treatment has failed? A systematic review. Eur Arch Psychiatry Clin Neurosci 2005; 255 (06) 387-400.
• 3 Adli M. et al. Safety of high-intensity treatment with the irreversible monoamine oxidase inhibitor tranylcypromine in patients with treatment-resistant depression. Pharmacopsychiatry 2008; 41 (06) 252-257.
• 4 Linden M. et al. Dosage finding and outcome of venlafaxine treatment in psychiatric outpatients and inpatients: results of a drug utilization observation study. Pharmacopsychiatry 2003; 36 (05) 197-205.
• 5 Bollin P. et al. Effectiveness of antidepressants. Meta-analysis of dose-effect relationships in randomised clinical trials. Br J Psychiatry 1999; 174: 297-303.
• 6 Baker CB. et al. Evidence that the SSRI dose response in treating major depression should be reassessed: a meta-analysis. Depress Anxiety 2003; 17 (01) 1-9.
• 7 Hiemke C, Hartter S. Pharmacokinetics of selective serotonin reuptake inhibitors. Pharmacol Ther 2000; 85 (01) 11-28.
• 8 Hjorth S. et al. Serotonin autoreceptor function and antidepressant drug action. J Psychopharmacol 2000; 14 (02) 177-185.
• 9 Jakubovski E. et al. Systematic review and meta-analysis: dose-response relationship of selective serotonin reuptake inhibitors in major depressive disorder. Am J Psychiatry 2016; 173 (02) 174-183.
• 10 Montgomery SA. et al. The optimal dosing regimen for citalopram – a meta-analysis of nine placebo-controlled studies. Int Clin Psychopharmacol 1994; (09) (Suppl. 01) 35-40
• 11 Corruble E, Guelfi JD. Does increasing dose improve efficacy in patients with poor antidepressant response: a review. Acta Psychiatr Scand 2000; 101 (05) 343-348.
• 12 Ruhe HG. et al. Dose escalation for insufficient response to standard-dose selective serotonin reuptake inhibitors in major depressive disorder: systematic review. Br J Psychiatry 2006; 189: 309-316.
• 13 Rector TS. et al. Outcomes of citalopram dosage risk mitigation in a veteran population. Am J Psychiatry. 2016 (PMID: appiajp201615111444)
• 14 Hicks JK. et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6 and CYP2C19 genotypes and dosing of selective serotonin reuptake inhibitors. Clin Pharmacol Ther 2015; 98 (02) 127-134.