Depressionsbehandlung heute

Zusammenfassung

Depressionen sind die häufigste psychiatrische Erkrankung. Rund 15 bis 20 % aller Menschen leiden mindestens einmal in ihrem Leben an einer depressiven Episode. Zur Therapie schneidet eine Kombination aus psychotherapeutischer und medikamentöser Behandlung besser ab als die jeweilige Monotherapie. Neue pharmakologische Optionen bieten der selektive Serotonin- und Noradrenalin-Wiederaufnahmhemmer Duloxetin sowie der enantiomerenreine selektive Serotonin-Wiederaufnahmehemmer Escitalopram. Bei bipolaren Depressionen sollte bei der Behandlung berücksichtigt werden, dass Antidepressiva einen Switch in die Manie auslösen können, weswegen gegebenenfalls eine phasenprophylaktische Therapie mit Stimmungsstabilisierern eingesetzt werden sollte.

Summary

Depressive states are the most common mental diseases. During the course of their lives some 15 to 20 % of the general population suffer from a depressive episode on at least one occasion. With regard to treatment, a combination of psychotherapeutic and pharmacotherapeutic measures proves to be superior to the respective monotherapy. New pharmacological options are available in the form of the selective serotonin and norepinephrine reuptake inhibitor, duloxetine, and the pure enantiomer selective serotonin reuptake inhibitor escitalopram. When treating bipolar depression, account must be taken of the fact that antidepressants may trigger a switch-over to the manic state, which implies that, whenever necessary, phase prophylactic therapy with mode-stabilizing drugs should be employed.

Key words

depression - treatment - diagnostic - psychotherapy

Literatur

• 1 Arsenault-Lapierre G, Kim C, Turecki G. Psychiatric diagnoses in 3275 suicides: a meta-analysis.  BMC Psychiatry. 2004;  4 37
• 2 Avery DH, Holtzheimer PE III, Fawaz W, Russo J, Neumaier J, Dunner DL, Haynor DR, Claypoole KH, Wajdik C, Roy-Byrne P. A Controlled Study of Repetitive Transcranial Magnetic Stimulation in Medication-Resistant Major Depression. Biol Psychiatry 2005
• 3 Blier P. The burden of depression and the challenge of its recognition and treatment.  CNS Spectrum. 2002;  7 119
• 4 DeRubeis RJ, Gelfand LA, Tang TZ, Simons AD. Medications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons.  Am J Psychiatr. 1999;  156 1007-13
• 5 Dowman J, Patel A, Rajput K. Electroconvulsive therapy: attitudes and misconceptions.  J ECT. 2005;  21 84-87
• 6 Elkin I, Shea MT, Watkins JT, Imber SD, Sotsky SM, Collins JF, Glass DR, Pilkonis PA, Leber WR, Docherty JP. et al. . National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments.  Arch Gen Psychiatry. 1989;  46 971-82
• 7 Furukawa TA, Konno W, Morinobu S. et al. . Course and outcome of depressive episodes: Comparison between bipolar, unipolar and subthreshold depression.  Psychiatry Research. 2000;  96 211-220
• 8 Furukawa TA, McGuire H, Barbui C. Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review.  BMJ. 2002;  325 991
• 9 Kessler RC, McGonagle KA, Nelson CB. et al. . Sex and depression in the National Comorbidity Survey. II: Cohort effects.  Journal of Affective Disorders. 1994;  30 15-26
• 10 Klerman GL, Weissmann MM. Interpersonal psychotherapy (IPT) and drugs in the treatment of depression.  Pharmacopsychiatry. 1987;  20 3-7
• 11 Lam RW, Kennedy SH. Evidence-based strategies for achieving and sustaining full remission in depression: focus on metaanalyses.  Can J Psychiatry. 2004;  49 17S-26S
• 12 Montgomery SA, Huusom AK, Bothmer J. A randomised study comparing escitalopram with venlafaxine XR in primary care patients with major depressive disorder.  Neuropsychobiology. 2004;  50 57-64
• 13 Murray CJL, Lopez AD. The global burden of disease and injury series, volume 1: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Published by the Harvard School of Public Health on behalf of the World Health Organization and the World Bank, Harvard University Press 1996
• 14 Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Combined pharmacotherapy and psychological treatment for depression: a systematic review.  Arch Gen Psychiatry. 2004;  61 714-9
• 15 Simons AD, Gordon JS, Monroe SM. et al. . Toward an integration of psychologic, social, and biologic factors in depression: Effects on outcome and course of cognitive therapy.  Journal of Consulting and Clinical Psychology. 1995;  63 369-377
• 16 Thase ME, Greenhouse JB, Frank E, Reynolds 3rd CF, Pilkonis PA, Hurley K, Grochocinski V, Kupfer DJ. Treatment of major depression with psychotherapy or psychotherapy-pharmacotherapy combinations.  Arch Gen Psychiatry. 1997;  54 1009-15
• 17 Thase ME. Achieving remission and managing relapse in depression.  J Clin Psychiatry. 2003;  64 3-7
• 18 Tohen M, Vieta E, Calabrese J. et al. . Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression.  Arch Gen Psychiatry. 2005;  60 1079-1088
• 19 Winkler D, Tauscher J, Kasper S. Maintenance treatment in depression.  Curr Op Psychiatry. 2002;  15 63-68

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