Phytotherapie bei Angsterkrankungen und Depressionen

Zusammenfassung

Phytotherapeutika sind in den aktuellen Versorgungsleitlinien für Angsterkrankungen und Depressionen aus Nordamerika, Großbritannien, Österreich und Deutschland sowie in den Empfehlungen der World Federation of Societies of Biological Psychiatry unterschiedlich stark repräsentiert. Bei Angsterkrankungen existieren derzeit keine Empfehlungen für pflanzliche Arzneimittel. In jüngster Zeit publizierte Ergebnisse, die die anxiolytische Wirksamkeit des Lavendelöl-Präparats Silexan nachweisen, haben noch keinen Niederschlag in den Leitlinien gefunden. Bei depressiven Störungen ist die Behandlung mit Hypericum-Extrakt in den Leitlinien gut etabliert und wird in 5 der 6 einbezogenen Guidelines als wirksame und gut verträgliche Alternative zu synthetischen Antidepressiva bei Patienten mit leichten oder mittelschweren Depressionen eingestuft.

Summary

phytotherapy of anxiety and depressive disorders. Representation in medicinal guidelines

Current disease management guidelines from North America, Great Britain, Austria and Germany as well as the recommendations of the World Federation of Societies of Biological Psychiatry differ in their representation of phytotherapeutic drugs for the treatment of anxiety and depressive disorders. None of the guidelines under review made recommendations on the phytotherapy of anxiety disorders. However, recent publications of studies demonstrating the anxiolytic efficacy of the lavender oil preparation, Silexan, have not yet been considered in the guidelines. On the other hand, the treatment of depressive disorders with Hypericum extract preparations is well established. Five of the six guidelines included in this review provide a positive assessment of Hypericum extract as an efficacious and well tolerated alternative to synthetic antidepressants in patients with mild or moderate depression.

Schlüsselwörter

Angststörung - Depression - Phytotherapeutika - Versorgungsleitlinien

Key words

Anxiety disorder - depressive disorder - phytotherapeutic drugs - disease management guidelines

• Literatur

• 1 American Psychiatric Association. Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Arlington, VA: American Psychiatric Association; 2004
• 2 American Psychiatric Association. Guideline watch (March 2009): Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Washington, DC: American Psychiatric Association; 2009
• 3 American Psychiatric Association. Practice guideline for the treatment of patients with panic disorder. Washington, DC: American Psychiatric Association; 2009
• 4 American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder. Arlington, VA: American Psychiatric Association; 2010
• 5 Bandelow B, Zohar J, Hollander E et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders – first revision. World J Biol Psychiatry 2008; 9: 248-312
• 6 Bauer M, Pfennig A, Severus E et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry 2013; 14: 334-385
• 7 Canadian Psychiatric Association. Clinical practice guidelines for the treatment of depressive disorders. 2001; https://ww1.cpaapc.org/Publications/Clinical_Guidelines/depression/clinicalGuidelinesDepression.asp
• 8 Canadian Psychiatric Association. Clinical practice guidelines. Management of anxiety disorders. Can J Psychiatry 2006; 51: 9S-91S
• 9 Demyttenaere K, Bruffaerts R, Posada-Villa J et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004; 291: 2581-2590
• 10 Dengler W, Selbmann H-K Hrsg. Leitlinien zur Diagnostik und Therapie von Angsterkrankungen. Darmstadt: Steinkopff; 2000
• 11 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN), Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (AWMF) Hrsg. Nationale Versorgungsleitlinie Unipolare Depression. Berlin, Düsseldorf: 2012
• 12 Izzo AA. Drug interactions with St. John's Wort (Hypericum perforatum): a review of the clinical evidence. Int J Clin Pharmacol Ther 2004; 42: 139-148
• 13 Kasper S, Gastpar M, Möller HJ et al. Better tolerability of St. John's wort extract WS 5570 compared to treatment with SSRIs: a reanalysis of data from controlled clinical trials in acute major depression. Int Clin Psychopharmacol 2010; 25: 204-213
• 14 Kasper S, Gastpar M, Müller WE et al. Wirksamkeit und Verträglichkeit von Silexan, einer neuen, oral verabreichten Zubereitung aus Lavendelöl, bei subsyndromaler Angststörung. Evidenz aus klinischen Prüfungen. Z Phytother 2011; 32: 60-63
• 15 Kasper S, Kapfhammer HP, Bach M et al. Angststörungen – Medikamentöse Therapie. Konsensus-Statement – State of the art 2009. CliniCum neuropsy 2009; 1-15
• 16 Kasper S, Lehofer M, Doering S et al. Depression – Medikamentöse Therapie. Konsensus-Statement – State of the art 2012. CliniCum neuropsy 2012; 1-23
• 17 Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database Syst Rev 2008; CD000448
• 18 National Collaborating Centre for Mental Health (NCCMH). Depression. The NICE guideline on the treatment and management of depression in adults. London: RCPsych Publications; 2010
• 19 National Collaborating Centre for Mental Health (NCCMH). Generalised Anxiety Disorder in Adults. The NICE Guideline on Management in Primary, Secondary and Community Care. London: RCPsych Publications; 2011
• 20 Perry R, Terry R, Watson LK, Ernst E. Is lavender an anxiolytic drug? A systematic review of randomised clinical trials. Phytomedicine 2012; 825-835
• 21 Volz HP, Gastpar M, Kasper S et al. Subsyndromale Angststörungen: Definition, Messparameter, Epidemiologie. Journal für Neurologie, Neuropsychiatrie und Psychiatrie 2011; 12: 162-167
• 22 Woelk H, Schläfke S. A multi-center, doubleblind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine 2010; 17: 94-99
• 23 World Health Organization. International statistical classification of diseases and related health problems, tenth revision (ICD-10). Geneva: World Health Organization; 1992