Subscribe to RSS
DOI: 10.1055/s-0032-1305013
Antidepressive Therapieoptimierung in einem Fall von chronisch-entzündlicher Darmerkrankung bei unipolarer Depression
Optimizing Antidepressant Pharmacotherapy in a Case of Inflammatory Bowel Disease and Major DepressionPublication History
Publication Date:
11 June 2012 (online)
Zusammenfassung
Anliegen: Dieser Fallbericht befasst sich mit den pharmakotherapeutischen Therapieoptionen bei subtherapeutischen Medikamentenspiegeln eines Patienten mit chronisch-entzündlicher Darmerkrankung und rezidivierender depressiver Störung.
Methode: Bei erniedrigten Plasmaspiegeln von Mirtazapin wendeten wir therapeutisches Drug Monitoring (TDM), Cytochrom-P450-2D6-Genotypisierung und die Umstellung der Galenik auf eine Darreichungsform mit oraler Wirkstofffreisetzung an.
Ergebnisse und Schlussfolgerung: Dadurch erzielten wir einen Anstieg der Plasmaspiegel von Mirtazapin und eine klinische Besserung.
Abstract
Objective: In the framework of a case report on a patient suffering from major depression and inflammatory bowel disease we address the pharmacotherapeutical options in case of subtherapeutic mirtazapine levels.
Methods: We applied therapeutic drug monitoring (TDM) and cytochrome P450 2D6 genotyping, and switched to an orodispersible tablet.
Results and Conclusion: Thus, mirtazapine plasma levels could be raised and clinical improvement of the depressive symptoms was achieved.
-
Literatur
- 1 DGPPN, BÄK, KBV, AWMF. Nationale Versorgungsleitlinie Unipolare Depression. Reihe: Interdisziplinäre S3-Praxisleitlinien. Berlin: Springer; 2010
- 2 Wiethoff K, Bauer M, Baghai TC et al. Prevalence and treatment outcome in anxious versus nonanxious depression: results from the German Algorithm Project. J Clin Psychiatry 2010; 71: 1047-1054
- 3 Bauer M, Pfennig A, Linden M et al. Efficacy of an algorithm-guided treatment compared with treatment as usual: a randomized, controlled study of inpatients with depression. J Clin Psychopharmacol 2009; 29: 327-333
- 4 Ricken R, Wiethoff K, Reinhold T et al. Algorithm-guided treatment of depression reduces treatment costs – Results from the randomized controlled German Algorithm Project (GAPII). J Affect Disord 2011; 134: 249-256
- 5 Moenter M. Wenn Leitlinien auf Versorgungswirklichkeit treffen. Sinn von Leitlinien aus Sicht niedergelassener Psychiater. Nervenarzt 2010; 81: 1069-1078
- 6 Adli M, Bauer M, Rush AJ. Algorithms and collaborative-care systems for depression: are they effective and why? A systematic review. Biol Psychiatry 2006; 59: 1029-1038
- 7 Williams LM, Rush AJ, Koslow SH et al. International Study to Predict Optimized Treatment for Depression (iSPOT-D), a randomized clinical trial: rationale and protocol. Trials 2011; 12: 4
- 8 Uher R, Perlis RH, Henigsberg N et al. Depression symptom dimensions as predictors of antidepressant treatment outcome: replicable evidence for interest-activity symptoms. Psychol Med 2011; 20: 1-14
- 9 Bares M, Brunovsky M, Kopecek M et al. Early reduction in prefrontal theta QEEG cordance value predicts response to venlafaxine treatment in patients with resistant depressive disorder. Eur Psychiatry 2008; 23: 350-355
- 10 Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56-62
- 11 Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio, TX: The Psychological Corporation; 1996
- 12 Hiemke C, Baumann PM, Bergemann N et al. AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Psychiatry: Update 2011. Pharmacopsychiatry 2011; 44: 195-235
- 13 Grasmäder K, Verwohlt PL, Kühn KU et al. Relationship between mirtazapine dose, plasma concentration, response, and side effects in clinical practice. Pharmacopsychiatry 2005; 38: 113-117
- 14 Timmer CJ, Sitsen JM, Delbressine LP. Clinical pharmacokinetics of mirtazapine. Clin Pharmacokinet 2000; 38: 461-474
- 15 Kast RE. Anti- and pro-inflammatory considerations in antidepressant use during medical illness: bupropion lowers and mirtazapine increases circulating tumor necrosis factor-alpha levels. Gen Hosp Psychiatry 2003; 25: 495-496
- 16 Kraus T, Haack M, Schuld A et al. Body weight, the tumor necrosis factor system, and leptin production during treatment with mirtazapine or venlafaxine. Pharmacopsychiatry 2002; 35: 220-225
- 17 Voortman G, Paanakke JE. Bioavailability of mirtazapine from Remeron® tablets after single and multiple oral dosing. Hum Psychopharmacol Clin Exp 1995; 10: 83-96
- 18 Van den Heuvel MW, Kleijn HJ, Peeters PAM. Bioequivalence Trial of Orally Disintegrating Mirtazapine Tablets and Conventional Oral Mirtazapine Tablets in Healthy Volunteers. Clin Drug Investig 2001; 21: 437-442
- 19 Norman TR, Olver JS. New formulations of existing antidepressants: advantages in the management of depression. CNS Drugs 2004; 18: 505-520
- 20 Zhou SF. Polymorphism of human cytochrome P450 2D6 and its clinical significance: Part I. Clin Pharmacokinet 2009; 48: 689-723
- 21 Sim SC, Ingelman-Sundberg M. The human cytochrome P450 Allele Nomenclature Committee Web site: submission criteria, procedures, and objectives. Methods Mol Biol 2006; 320: 183-191