Depressive Störungen bei Morbus Parkinson werden zu selten diagnostiziert und therapiert, obwohl sie bei 40 % aller Patienten auftreten. An ihrer Pathogenese sind organische und psychologische Faktoren beteiligt. Sie beeinträchtigen als einer von drei wichtigen Faktoren die Lebensqualität. Die Diagnostik kann mit Hilfe von Fremd- und Selbstbeurteilungsskalen vereinfacht werden. Eine Optimierung der dopamimetischen Medikation reicht bei den meisten Patienten nicht aus, sodass die Gabe eines Antidepressivums erforderlich wird. Die derzeitige Studienlage zur Wirksamkeit und Verträglichkeit der Antidepressivatherapie bei Morbus Parkinson erlaubt keine evidenzbasierten Therapieempfehlungen. Obwohl die neueren Antidepressiva wie die selektiven Serotoninwiederaufnahmehemmer im Vergleich zu den älteren Antidepressiva wie den trizyklischen Antidepressiva keine bessere Wirksamkeit zeigen, werden sie aufgrund ihres günstigeren Nebenwirkungsprofils bei älteren Patienten, einfacherer Aufdosierung und ihres geringeren Interaktionspotenzials häufiger verordnet. Die vorgestellten Therapieempfehlungen leiten sich aus pharmakologischen Überlegungen, klinischer Erfahrung, der zu behandelnden Zielsymptomatik und Art und Intensität von Nebenwirkungen ab.
Abstract
Although affecting 40 % of all patients suffering from Parkinson's disease, depression is often neither diagnosed nor treated. Biological and psychological factors contribute to the pathogenesis of depression. As one of three important factors, depressive disorders influence quality of life. The difficulties of diagnosing depression could be overcome by the use of rating instruments like the Beck Depression Inventory or the Montgomery Asberg Depression Scale. Improving the dopaminergic medication is in most of the cases not sufficient enough, so there is need for the use of an antidepressant. Data on the efficacy and the safety of antidepressive treatment in Parkinson's disease are currently too limited to give evidence-based recommendations. Although newer antidepressants like the selective serotonin reuptake inhibitors and older ones like the tricyclic antidepressants are equally effective, the newer ones are recommended more often because of their more favorable adverse effects in older patients, easier dosing and less interactions. The following recommendations depend on pharmacological considerations, clinical experience, the intended-to-treat symptoms and the kind and intensity of adverse effects.
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