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
