Rapid Cycling bei bipolar-affektiven Störungen: Klinik, Ätiologie und Behandlungsempfehlungen

Zusammenfassung

Rapid Cycling stellt eine in der klinischen Praxis häufige Verlaufsform bipolarer Erkrankungen dar mit einer durchschnittlichen Lebenszeitprävalenz von bis zu 31 %. Neben der ausgeprägten Symptomschwere, einer erhöhten Suizidalität und der höheren Rate an Komorbiditäten sind vor allem der langfristig schlechtere Verlauf und ein reduziertes Therapieansprechen komplizierende Merkmale des Rapid Cycling im Vergleich zum Verlauf einer bipolaren Erkrankung ohne Rapid Cycling. Häufig stellt das Rapid Cycling jedoch kein stabiles Charakteristikum bipolarer Erkrankungen dar, wenngleich die Wahrscheinlichkeit seines Auftretens mit der Dauer der Erkrankung ansteigt. Faktoren, die u. a. mit dem Auftreten von Rapid Cycling assoziiert wurden, sind weibliches Geschlecht, Hypothyreose sowie die medikamentöse Therapie mit Antidepressiva. Die Klärung einer kausalen Genese dieser Faktoren für das Auftreten von Rapid Cycling ist jedoch aufgrund ihrer komplexen Interaktionen untereinander und mit weiteren Faktoren nicht möglich. Hinsichtlich der Therapieoptionen stehen nur wenige Daten aus kontrollierten Untersuchungen zur Verfügung. Basierend darauf ist Lithium, im Gegensatz zu früheren Annahmen, ähnlich wirksam wie Antikonvulsiva. Positive Wirksamkeitsnachweise für atypische Antipsychotika existieren vor allem aus placebokontrollierten und herstellerfinanzierten Studien. Insgesamt fehlen für eine differenzierte Therapieempfehlung unabhängige, prospektive Studien, die auch Vergleiche einzelner Substanzen untereinander umfassen. Es ist weiterhin unklar, welche Rolle die medikamentöse Therapie mit Antidepressiva in der Genese bzw. Phasenakzeleration bei bipolaren Erkrankungen spielt. Hinweise für einen entsprechenden negativen Einfluss konnten in einigen Untersuchungen gefunden werden, so dass der Einsatz von Antidepressiva bei Rapid Cycling sehr kritisch hinterfragt werden sollte.

Abstract

Rapid cycling bipolar disorder is encountered frequently in clinical practice with a lifetime prevalence of up to 31 %. Besides its association with greater illness severity, increased suicide and comorbidity rates, rapid cycling bipolar disorder has been closely associated with a longer and more complicated course of disease and inadequate treatment response compared to non-rapid cycling bipolar disorder. However rapid cycling does not serve as a stable characteristic of bipolar disorder, though its prevalence increases with illness duration. Female gender, hypothyreoidism and antidepressant medications have been suggested as correlates of rapid cycling bipolar disorder; however, the interaction amongst these factors make an interpretation of their causal relations difficult. Only very few data are available from randomized clinical trials that investigated the therapeutic options of rapid cycling bipolar disorder. Based on these trials, the therapeutic outcome of lithium is similar to that of the class of anticonvulsants. Positive treatment outcome reported for atypical neuroleptics is often based on pharmaceutical company-financed, placebo-controlled RCTS. Altogether independent prospective RCTs and head-to-head comparisons are lacking that can provide sufficient information on treatment response. In addition, the role of antidepressant treatment in the course and phase acceleration of bipolar disorder remains insufficiently understood. However, in the light of present empirical evidence, the use of antidepressant medication in the treatment of rapid cycling bipolar disorder has to be looked at highly critically.

Schlüsselwörter

Rapid Cycling - Symptome - Ätiologie - Behandlungsempfehlungen

Key words

rapid cycling - symptoms - background - treatment recommendations

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