Angststörungen - Trends in der psychopharmakologischen Behandlung

Zusammenfassung

Rationalen und Ziele für die Entwicklung neuer Psychopharmaka in der Behandlung von Angststörungen sind neben einer guten Wirksamkeit ein rascher Wirkungsbeginn, gute Verträglichkeit und ausbleibende Toleranz- und Absetzeffekte. Zeitgemäße Entwicklungen zeigen Trends in der Entwicklung selektiver wirksamer serotonerger Substanzen und GABA-Modulatoren, die keine den Benzodiazepinen vergleichbaren unerwünschten Effekte zeigen. Besonders vielversprechende Ansätze zeigen Neuropeptidliganden, die in bestimmte Prozesse bei Angststörungen eingreifen. Hierzu rechnet man im Besonderen Liganden für CCK-4, Substanz-P, Neuropeptid-Y und Sigma-Rezeptoren. Ein wesentlicher zukünftiger Stellenwert ist von Substanzen zu erwarten, die Prozesse im Rahmen der neuroendokrinologischen Stressregulation modulieren, wie CRH-Rezeptorantagonisten und ANP-Agonisten. Viele dieser Strategien sind allerdings noch in frühen Phasen der klinischen Prüfung.

Summary

The rationale for, and the aims of, the development of new psychopharmacological substances for the treatment of anxiety disorders are, in addition to effectiveness, a rapid onset of effect, good tolerability and an absence of tolerance and discontinuation effects. Modern developments reveal trends in the development of selectively effective serotonergic substances and GABA modulators, which show none of the undesired effects comparable with those seen with benzodiazepines. Particularly promising approaches are the neuropeptide ligands that interfere with certain processes in anxiety disorders. These substances include in particular ligands for CCK-4, substance P, neuropeptide Y, and sigma receptors. A major future impact is to be expected from substances that modulate processes within the framework of neuroendocrinal stress regulation, such as CRH receptor antagonists and ANP agonists. It must be noted, however, that many of these strategies are still in the early stages of clinical testing.

Key Words

therapeutic interventions - anxiety - panic disorders - new strategies

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