Zusammenfassung
Bis vor einigen Jahren hat sich die medikamentöse Behandlung zur Verhinderung von
Rückfällen bei bipolaren Erkrankungen in erster Linie auf Lithium beschränkt, das
sich vor allem bei den typischen, klassischen Verläufen der bipolaren Störungen mit
seiner stimmungsstabilisierenden Wirkung und antisuizidalem Effekt günstig auf den
Krankheitsverlauf auswirkt. Bei atypischen Symptomen oder schnellem Phasenwechsel
jedoch scheint die Effektivität eingeschränkt, mit der Konsequenz, dass weitere Therapieoptionen,
v. a. Antiepileptika wie Carbamazepin, Valproat oder Lamotrigin auch in der Indikation
der prophylaktischen Anwendung untersucht wurden. Auch atypische Neuroleptika, Schilddrüsenhormone
und Omega-Fettsäuren wurden in Langzeitstudien bezüglich stimmungsstabilisierender
Effekte untersucht. Der vorliegende Artikel fasst den gegenwärtigen Stand zur Wirksamkeit
der verschiedenen Therapieoptionen in der Langzeittherapie zusammen.
Abstract
Until recently, the psychopharmacological treatment alternatives for bipolar maintenance
treatment were limited to lithium, which seems of special usefulness in a classical
manifestation of the illness with mood-stabilising and anti-suicidal properties. With
atypical features like psychotic symptoms or rapid cycling, lithium seems to be less
useful. This led to further research into alternative options as carbamazepine, valproate
or lamotrigine as well as atypical neuroleptics, thyroid hormones or innovative substances
like omega fatty acids. This article summarises the current state of knowledge on
treatment options for maintenance therapy.
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Dr. med. Heinz Grunze
Psychiatrische Klinik der LMU
Nussbaumstraße 7
80336 München
Email: Heinz.Grunze@med.uni-muenchen.de
