Pharmakologische Behandlungsmöglichkeiten bei therapieresistenter Depression

Zusammenfassung

Die therapieresistente Depression (TRD) ist ein häufiges Problem in der klinischen Versorgung. Im Gegensatz zu depressiven Episoden hat die TRD eine schlechtere klinische, funk-tionelle und soziale Prognose. Es besteht eine Reihe von Optionen zur Therapie der TRD, die Evidenzlage ist – nicht zuletzt aufgrund der uneinheitlichen Operationalisierung von TRD – schmal. Neue Therapiestrategien, die auf eine Veränderung von Neurotransmittersystemen außerhalb der klassischen Monoaminhypothese zielen, werden mit vielversprechenden Ergebnissen untersucht. Augmentations- und Kombinationsstrategien mit Lithium, atypischen Neuroleptika und neueren Antidepressiva sind eine interessante und valide Option.

Summary

Treatment-resistant depression (TRD) is frequently been observed in patients with severe mental disorders. The clinical course, functional and social prognosis is worse in TRD compared to patients with depressive episodes. Several options exist for the treatment of TRD, including pharmacologic treatment beyond the “classical” monoamine hypothesis of depression. Augmentation with lithium or atypical neuroleptics, and combination treatments are promising strategies. Cognitive-behavioral psychotherapy and “third wave” psychotherapies should always be considered as part of the treatment plan.

Schlüsselwörter

Therapieresistente Depression - Augmentation - Switching - Kombination - Psychotherapie

Keywords

Treatment-resistant depression - augmentation - switching - combination - psychotherapy

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