Moderne antidepressive Therapie

Zusammenfassung

Anliegen Literaturübersicht aktueller pharmakologischer Behandlungsempfehlungen und evidenzbasierter Leitlinien in der Akutbehandlung der schweren depressiven Episode. Methode Systematische Auswertung aktueller peer-reviewed Übersichtsarbeiten, Metaanalysen und Behandlungsleitlinien im Hinblick auf evidenzbasierte Schlussfolgerungen für die konkrete psychiatrische Praxis. Ergebnisse Im Gegensatz zur Wirksamkeit, die bei den Antidepressiva im Wesentlichen ähnlich ist, herrschen bezüglich der Verträglichkeit zum Teil große Unterschiede, die den Einsatz im psychiatrischen Alltag maßgeblich bestimmen. Für den Fall einer häufig vorkommenden Therapieresistenz existieren gut untersuchte Algorithmen für eine optimale Weiterbehandlung. Schlussfolgerungen Die Vielzahl wirksamer antidepressiver Verfahren lässt eine individuelle und patientengerechte Behandlung zu. Eine Orientierung an festgelegten Stufenplänen sichert das optimale Ausschöpfen dieser Möglichkeiten.

Abstract

Objective A systematic review on empirical results of current guidelines and recommendations with focus on efficacy and tolerability of antidepressant pharmacological treatment options. Methods A critical, systematic evaluation of peer reviewed surveys, meta-analyses and guidelines is provided with the focus on evidence based consequences for the psychiatric clinical practice in the treatment of major depressive episodes. Results Most of modern and classic antidepressants have not proved differences in studies regarding comparative effectiveness. In contrast clinical decisions are increasingly guided by differences of tolerability, which are clearly documented in the current literature. Many algorithm based treatment options exist to face the common problem of treatment resistance. Conclusions The multitude of effective antidepressant options provides an individual and patient orientated treatment. To achieve an optimal utilization of these options, an orientation on multi-step treatment plans is useful.

Schlüsselwörter

Depression - Pharmakotherapie - Therapieresistenz - Stufenplan - Übersicht

Key words

depression - pharmacologic treatment - treatment resistance - treatment plan - review

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