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Pharmakologische Behandlung der bipolaren Depression

Evidenz aus klinischen Leitlinien und Behandlungsempfehlungen

verfasst von: Dr. S. Köhler, M. Bauer, T. Bschor

Erschienen in: Der Nervenarzt | Ausgabe 9/2014

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Zusammenfassung

Die Behandlung der bipolaren Depression stellt die Ärzte im klinischen Alltag vor teilweise komplexe Entscheidungen. Die beste Evidenz in der pharmakologischen Behandlung besteht für Quetiapin, eingeschränkt auch für das hierfür nicht zugelassene Lamotrigin (insbesondere auch in der Kombination mit Lithium), Carbamazepin und Olanzapin. Die Wirksamkeit und Empfehlung von Antidepressiva in der Behandlung der bipolaren Depression ist bei bisher unzureichender Datenlage umstritten. Zunächst sollte bei depressiven Episoden eine Phasenprophylaxe begonnen oder eine bestehende Phasenprophylaxe optimiert und bei stärkerer Ausprägung mit einer der genannten antidepressiv wirksamen Substanzen behandelt werden. Bei Nonresponse kann die Kombination von Lithium und Lamotrigin oder die Gabe eines Antidepressivums in Kombination mit Lithium, Antiepileptika oder atypischen Antipsychotika notwendig sein. Bei depressiven Episoden unter bestehender Phasenprophylaxe sind Kombinationsbehandlungen der verschiedenen Substanzen, teilweise auch mit Antidepressiva, notwendig. Bei Therapieresistenz der depressiven Episode sind komplexere Behandlungsstrategien (z. B. Kombinationstherapien, MAO-Hemmer) zu berücksichtigen.

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Titel: Pharmakologische Behandlung der bipolaren Depression
Evidenz aus klinischen Leitlinien und Behandlungsempfehlungen
verfasst von: Dr. S. Köhler
M. Bauer
T. Bschor
Publikationsdatum: 01.09.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Der Nervenarzt / Ausgabe 9/2014
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI: https://doi.org/10.1007/s00115-013-3919-0

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