Pharmakotherapie von Anorexia nervosa und Bulimia nervosa: State of the Art

 

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Zusammenfassung

Sowohl für Magersucht (Anorexia nervosa, AN) als auch für Bulimia nervosa (BN), ist Psychotherapie die Therapie der ersten Wahl. In der Praxis werden häufig auch medikamentöse Behandlungen durchgeführt. Der Kliniker steht bei der Auswahl der geeigneten Pharmakotherapie vor Schwierigkeiten (z. B. limitierter Zulassungsstatus von Medikamenten, schwer kalkulierbare Pharmakodynamik bei Untergewicht oder Purgingverhalten, Behandlungsbedarf komorbider Störungen). Die vorliegende Übersicht fasst den gegenwärtigen, leitlinienorientierten Kenntnisstand zur Pharmakotherapie von AN und BN zusammen. Grundsätzlich ist die Studienlage bei der AN noch unzureichend. Es existiert bislang kein Wirksamkeitsnachweis für Antidepressiva und atypische Neuroleptika hinsichtlich einer Gewichtszunahme; letztere können aber bei Gedankenkreisen und Bewegungsdrang hilfreich sein. Bei der BN sind Antidepressiva das medikamentöse Behandlungsverfahren der ersten Wahl. Langzeiteffekte sind allerdings noch unbekannt.

Abstract

Psychotherapy is the treatment of choice for both anorexia nervosa and for bulimia nervosa. However, many patients are also treated by pharmaceutical drugs. For the clinician it is difficult to choose pharmacotherapy, because the drugs may not be licensed, because of pharmacodynamic problems due to underweight or purging behaviour, or because of comorbidity. The present review summarises the current knowledge on pharmacotherapy for anorexia nervosa and bulimia nervosa considering the available guidelines. In general, the knowledge based on studies is insufficient for anorexia nervosa. Up to now, there is no proof of efficacy for any antidepressant or atypical antipsychotic with respect to weight gain; atypical antipsychotics may be helpful for ruminating or excessive motor hyperactivity. For bulimia nervosa antidepressants are the pharmacotherapy of first choice. Long-term effects, however, are still unknown.

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