Zusammenfassung
Bei Depressionen im Rahmen eines bipolaren Verlaufs soll eine Behandlung mit Antidepressiva nur unter gleichzeitiger medikamentöser Stimmungsstabilisierung stattfinden, damit das Risiko des Umschlagens in die Manie und des Rapid cyclings vermindert wird. Die Antidepressiva werden meist in Analogie zur unipolaren Depression eingesetzt; Studien existieren nur wenige. Nach einer schweren Depression soll bei bipolarem Verlauf neben dem Stimmungsstabilisierer eine Erhaltungstherapie mit dem zuletzt verwendeten Antidepressivum folgen (ausgenommen bei Rapid cycling), nach psychotischer Depression auch mit einem Neuroleptikum. Es werden die Möglichkeiten bei Therapieresistenz beschrieben. Unter den Stimmungsstabilisierern wirken nur Lithium und Lamotrigin per se antidepressiv. Von den neueren Antipsychotika erhofft man sich auch in Bezug auf die Depression einen stimmungsstabilisierenden Effekt.
Abstract
In bipolar disorder, the treatment with an antidepressant has to be combined with a mood stabilizer in order to avoid a switch to mania and the development of rapid cycling. As there are only a few studies, antidepressants are used in analogy to unipolar depression. After a severe bipolar depression, a maintenance therapy with the antidepressant last used is necessary parallel to mood stabilization (except in rapid cycling); after psychotic depression also with a neuroleptic. The options in case of therapy resistance are discussed. Among the mood stabilizers, only lithium and lamotrigine possess an antidepressant effect per se. The new antipsychotics might have mood-stabilizing effects against depression also.
Schlüsselwörter
Bipolare affektive Störung - Depression - Therapieresistenz - Switch
Key words
Bipolar disorder - Depression - Therapy resistance - Switch
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Dr. med. J. Nebe
Klinik für Psychiatrie und Psychotherapie der Universität Essen
Rheinische Kliniken Essen
Virchowstr. 174
45147 Essen
eMail: johannes.nebe@uni-essen.de
