Depressionen und Lebererkrankungen: Die Rolle von Mikrobiom und Inflammation

Kai G. Kahl; Tillmann Krüger; Gabriel Eckermann; Heiner Wedemeyer

doi:10.1055/s-0043-123068

Fortschritte der Neurologie · Psychiatrie, Inhaltsverzeichnis

Fortschr Neurol Psychiatr 2019; 87(01): 12-21
DOI: 10.1055/s-0043-123068

Übersicht

Depressionen und Lebererkrankungen: Die Rolle von Mikrobiom und Inflammation

Major depression and liver disease: the role of microbiome and inflammation

Kai G. Kahl

¹Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover

²Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie, Arbeitsgruppe Polypharmazie

,

Tillmann Krüger

¹Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover

,

Gabriel Eckermann

²Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie, Arbeitsgruppe Polypharmazie

,

Heiner Wedemeyer

³Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover Gastroenterologie, Hepatologie und Endokrinologie

› Institutsangaben

Abstract

Zusammenfassung

Zwischen Depressionen und Lebererkrankungen besteht ein e nger Zusammenhang. Jeder dritte Leberzirrhosepatient und jeder dritte Hepatitispatient ist depressiv. Andererseits entwickelt jeder dritte Patient mit Depressionen im Verlauf seines Lebens eine Alkoholerkrankung, in deren Folge Lebererkrankungen auftreten können. Ein entscheidendes Bindeglied zwischen Lebererkrankungen und Depressionen sind Entzündungsprozesse. Das systemische inflammatorische Milieu ist bei vielen Lebererkrankungen verändert. Außerdem scheint das Mikrobiom und eine erhöhte intestinale Permeabilität des Darms eine große Bedeutung zu haben. Sowohl Depressionen als auch Lebererkrankungen, Alkoholkonsum, Stress und Altersprozesse verschieben das empfindliche Gleichgewicht der Darmmikrobiota und resultieren in einer erhöhten intestinalen Permeabilität. Bakterien und ihre Metabolite wie das Endotoxin Lipopolysaccharid können so in die Blutzirkulation gelangen und sowohl in der Leber als auch im Gehirn über eine Zytokinkaskade Entzündungen auslösen, die wiederum zu Leberveränderungen sowie zu Depressionen, Adipositas und metabolischem Syndrom führen. Daher sollten bei depressiven Erkrankungen Leberentzündungswerte wie auch Marker für die Lebersynthese und Leberentgiftungsfunktion regelmäßig kontrolliert werden. Umgekehrt sollte bei Patienten mit Lebererkrankungen verstärkt auf depressive Symptome geachtet werden, die eine differentielle Therapie unter Berücksichtigung des Stadiums der Lebererkrankung erfordern.

Abstract

Depression and liver disease are closely associated. Every third patient with liver cirrhosis or hepatitis shows depressive symptoms. On the other hand, every third patient with depressive disorder develops an alcohol disorder at some point during his / her life. A crucial link between depression and hepatic disease seems to be inflammatory processes in which the microbiome and increased intestinal permeability of the intestine play a pivotal role. Depression as well as liver disease, alcohol consumption, stress, and aging processes disturb the delicate balance of intestinal microbiota resulting in increased intestinal permeability. Therefore, bacteria or their metabolites such as the endotoxine lipopolysaccharide are able to reach the blood circulation resulting in inflammation in the liver as well as in the brain via a cytokine cascade, which in turn can lead to liver changes, depression, obesity, and metabolic syndrome. Therefore, liver values, blood glucose levels, and metabolic parameters should be closely monitored in patients with depressive disorders, and in the case of patients with hepatic diseases, increased attention should be given to depressive symptoms, diabetes and obesity.

Schlüsselwörter

Depression - Lebererkrankung - Mikrobiom - Inflammation

Key words

major depressive disorder - liver disease - microbiome - inflammation

Volltext

Referenzen

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