Zusammenfassung
In Kohortenstudien wurden eine erhöhte Prävalenz depressiver Störungen bei diabetischen Patienten gezeigt. Trotz zahlreicher Untersuchungen sind die zugrundeliegenden Entstehungsmechanismen bisher nicht vollständig geklärt. Eine Rolle spielen vermutlich eine erhöhte Ausschüttung der am Glukosestoffwechsel beteiligten gegenregulierenden Hormone, Veränderungen des transmembranösen Glukosetransports und eine erhöhte inflammatorische Antwort. Die Diagnosestellung „Depression” bei diabetischen Patienten kann dadurch erschwert sein, dass typische depressive Symptome wie Müdigkeit, Antriebslosigkeit, verminderter Appetit oder sexuelle Funktionsstörungen auch Ausdruck des Diabetes mellitus selbst sein können. Bei der antidepressiven Behandlung ist darauf zu achten, dass es nicht zu einer pharmakogenen Induktion oder zur Verschlechterung einer diabetischen Stoffwechsellage kommt. Selektive Serotoninrückaufnahmehemmer, Venlafaxin und MAO-Inhibitoren scheinen diesbezüglich besonders günstig zu sein. Vorsicht sollte beim Einsatz von atypischen Antipsychotika gelten, da insbesondere Clozapin und Olanzapin, aber auch Quetiapin und Risperidon den Zuckerstoffwechsel negativ beeinflussen können.
Summary
Cohort studies indicate a high prevalence of depression in patients with diabetes mellitus. Despite numerous investigations, the underlying pathophysiologies of the metabolic abnormalities are poorly understood. A possible role play the increased counter-regulatory hormone release involved in glucose homeostasis, alterations in the glucose transport function and increased inflammatory activation triggered by depression. The diagnose of „depression” in diabetic patients might be hampered by similar symptoms of both conditions as fatigue, psychomotor inhibition, reduced appetite or sexual dysfunction. In treating depressive patients with diabetes one should consider potential induction or worsening of diabetes-like metabolic alterations. Selective serotonin-reuptake-inhibitors, venlafaxin and MAO-Inhibitors constitute a beneficial choice. Atypical antipsychotics like clozapine, olanzapine, quetiapine and risperidone should be given with precaution due to potential effects on glucose homeostasis.
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Francesca Regen
Klinik und Hochschulambulanz für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin
Eschenallee 3
14050 Berlin
Phone: 030/8445 8351
Fax: 030/8445 8365
Email: francesca.regen@charite.de
