Depression und Alkoholabhängigkeit

Zusammenfassung

Die Therapie depressiver Störungen von alkoholabhängigen Patienten stellt im klinischen Alltag eine Herausforderung dar. Beispielsweise erschweren gesetzliche Rahmenbedingungen den Zugang zu einer notwendigen psychotherapeutischen Behandlung. So stellt z. B. die Forderung einer dauerhaften Abstinenz eine Voraussetzung für die Kostenübernahme einer psychotherapeutischen Behandlung dar. Konträr zu solchen Forderungen, die nicht mit dem gegenwärtigen Forschungsstand zu neurobiologischen Grundlagen von Suchterkrankungen vereinbar sind, zeigen klinische Studien, dass die gleichzeitige Behandlung von Depression und Abhängigkeitserkrankung den größten Therapieerfolg bringen. Im Hinblick auf die Pharmakotherapie bietet sich eine kombinierte Behandlung mit rückfallprophylaktischen und antidepressiven Medikamenten an. Psychotherapeutisch kann eine Kombination aus motivationssteigernden Ansätzen und kognitiv-verhaltenstherapeutischen Verfahren die effektive Behandlung beider Störungen ermöglichen.

Summary

The treatment of depressive disorders in alcohol-dependent patients is often a difficult clinical challenge. For example, regulatory framework inhibits the access to psychotherapeutic treatment. So, the demand of a permanent abstinence is a prerequisite for the reimbursement of psychotherapeutic treatment. Contrary to those claims that are not compatible with the current state of research on the neurobiological basis of addiction, clinical studies show that combined treatment strategies including the simultaneous treatment of depression and addictive disorders lead to higher therapeutic success rates. Regarding pharmacotherapy, a combined treatment with drugs for relapse prevention and antidepressives may be considered useful. Psychotherapeutically, a combination of motivation-enhancing approaches and cognitivebehavioral methods can be considered an effective treatment of both disorders.

Schlüsselwörter

Alkoholabhängigkeit - Depression - Rückfallprophylaxe - Psychotherapie

Keywords

Alcohol dependence - depression - relapse prevention - psychotherapy

• Literatur

• 1 Hillemacher T, Bleich S. Zukünftige Herausforderungen in der Versorgung alkoholabhängiger Patienten. Fortschr Neurol Psychiatr 2008; 76 (Suppl. 02) 67-8.
• 2 Karagülle D. et al. Rauschtrinken bei Jugendlichen und jungen Erwachsenen. Fortschr Neurol Psychiatr 2010; 78 (Suppl. 04) 196-202.
• 3 Heberlein A. et al. Pharmakologische Therapieoptionen zur Prävention des Alkoholrückfalls. Fortschr Neurol Psychiatr 2008; 76 (Suppl. 07) 421-8.
• 4 Hillemacher T. Biological mechanisms in alcohol dependence – new perspectives. Alcohol Alcohol 2011; 46 (Suppl. 03) 224-30.
• 5 Feuerlein W. Alkoholismus – Warnsignale – Vorbeugung – Therapie. 6. Auflage. München: C. H. Beck; 2008
• 6 Kiefer F, Jahn H, Schick M, Wiedemann K. Alcohol self-administration, craving and HPA-axis activity: an intriguing relationship. Psychopharmacology (Berl) 2002; 164 (Suppl. 02) 239-40.
• 7 Kiefer F, Wiedemann K. Neuroendocrine pathways of addictive behaviour. Addict Biol 2004; 9 3–4 205-12.
• 8 Hillemacher T, Kornhuber J, Bleich S. Neurobiologische Mechanismen und Pharmakologische Behandlungsansätze des Alkohol-Craving. Fortschr Neurol Psychiatr 2007; 75 (Suppl. 01) 26-32.
• 9 Olive MF. et al. A role for corticotropin releasing factor (CRF) in ethanol consumption, sensitivity, and reward as revealed by CRF-deficient mice. Psychopharmacology (Berl) 2003; 165 (Suppl. 02) 181-7.
• 10 Fahlke C. et al. Metyrapone-induced suppression of corticosterone synthesis reduces ethanol consumption in high-preferring rats. Pharmacol Biochem Behav 1994; 48 (Suppl. 04) 977-81.
• 11 Junghanns K. et al. Impaired serum cortisol stress response is a predictor of early relapse. Alcohol Alcohol 2003; 38 (Suppl. 02) 189-93.
• 12 Hillemacher T. et al. Appetite- and volume-regulating neuropeptides: Role in treating alcohol dependence. Curr Opin Investig Drugs 2011; 11 (Suppl. 10) 1097-106.
• 13 Hillemacher T. et al. Influence of beer, wine and spirits consumption on craving. Addict Biol 2005; 10 (Suppl. 02) 181-6.
• 14 Hillemacher T. et al. Volume intake and craving in alcohol withdrawal. Alcohol Alcohol 2006; 41 (Suppl. 01) 61-5.
• 15 Kiefer F. et al. Involvement of plasma atrial natriuretic peptide in protracted alcohol withdrawal. Acta Psychiatr Scand 2002; 105 (Suppl. 01) 65-70.
• 16 Döring WK. et al. Persistent alterations of vasopressin and N-terminal proatrial natriuretic peptide plasma levels in long-term abstinent alcoholics. Alcohol Clin Exp Res 2003; 27 (Suppl. 05) 849-61.
• 17 Hillemacher T. et al. Epigenetic regulation and gene expression of vasopressin and atrial natriuretic peptide in alcohol withdrawal. Psychoneuroendocrinology 2009; 34 (Suppl. 04) 555-60.
• 18 Kiefer F. et al. Leptin: a modulator of alcohol craving?. Biol Psychiatry 2001; 49 (Suppl. 09) 782-7.
• 19 Nicolas JM. et al. Increased circulating leptin levels in chronic alcoholism. Alcohol Clin Exp Res 2001; 25 (Suppl. 01) 83-8.
• 20 Hillemacher T. et al. Role of appetite-regulating peptides in alcohol craving: an analysis in respect to subtypes and different consumption patterns in alcoholism. Alcohol Clin Exp Res 2007; 31 (Suppl. 06) 950-4.
• 21 Hillemacher T. et al. Evidence of an association of leptin serum levels and craving in alcohol dependence. Psychoneuroendocrinology 2007; 32 (Suppl. 01) 87-90.
• 22 Herrmann-Lingen C. et al. High plasma levels of N-terminal proatrial natriuretic peptide associated with low anxiety in severe heart failure. Psychosom Med 2003; 65 (Suppl. 04) 517-22.
• 23 Wiedemann K. et al. Anxiolyticlike effects of atrial natriuretic peptide on cholecystokinin tetrapep-tide-induced panic attacks: preliminary findings. Arch Gen Psychiatry 2001; 58 (Suppl. 04) 371-7.
• 24 Woody GE, O’Brien CP, Rickels K. Depression and anxiety in heroin addicts: a placebo-controlled study of doxepin in combination with methadone. Am J Psychiatry 1975; 132 (Suppl. 04) 447-50.
• 25 Lejoyeux M. Use of serotonin (5-hydroxytrypta-mine) reuptake inhibitors in the treatment of alcoholism. Alcohol Alcohol Suppl 1996; 1: 69-75.
• 26 Kenna GA. Medications acting on the serotonergic system for the treatment of alcohol dependent patients. Curr Pharm Des 2010; 16 (Suppl. 19) 2126-35.
• 27 Brady KT. et al. Sertraline in the treatment of co-occurring alcohol dependence and posttraumatic stress disorder. Alcohol Clin Exp Res 2005; 29 (Suppl. 03) 395-401.
• 28 Deas D, Randall CL, Roberts JS, Anton RF. A double-blind, placebo-controlled trial of sertraline in depressed adolescent alcoholics: a pilot study. Hum Psychopharmacol 2000; 15 (Suppl. 06) 461-9.
• 29 Muhonen LH, Lonnqvist J, Juva K, Alho H. Double-blind, randomized comparison of memantine and escitalopram for the treatment of major depressive disorder comorbid with alcohol dependence. J Clin Psychiatry 2008; 69 (Suppl. 03) 392-9.
• 30 Chick J, Aschauer H, Hornik K. Efficacy of fluvoxa-mine in preventing relapse in alcohol dependence: a one-year, double-blind, placebo-controlled multicentre study with analysis by typology. Drug Alcohol Depend 2004; 74 (Suppl. 01) 61-70.
• 31 Petrakis I. et al. Naltrexone and disulfiram in patients with alcohol dependence and current depression. J Clin Psychopharmacol 2007; 27 (Suppl. 02) 160-5.
• 32 Lejoyeux M, Lehert P. Alcohol-use disorders and depression: results from individual patient data meta-analysis of the acamprosate-controlled studies. Alcohol Alcohol 2011; 46 (Suppl. 01) 61-7.
• 33 Hillemacher T. et al. Opioid modulators for alcohol dependence. Expert Opin Investig Drugs 2010; 19: 1451-9.
• 34 Kiefer F. et al. Pharmacological relapse prevention of alcoholism: clinical predictors of outcome. Eur Addict Res 2005; 11 (Suppl. 02) 83-91.
• 35 Pettinati HM. et al. A double-blind, placebo-controlled trial combining sertraline and naltrexone for treating co-occurring depression and alcohol dependence. Am J Psychiatry 2010; 167 (Suppl. 06) 668-75.
• 36 Kranzler HR. et al. A double-blind, randomized trial of sertraline for alcohol dependence: moderation by age and 5-hydroxytryptamine transporter-linked promoter region genotype. J Clin Psycho-pharmacol 2011; 31 (Suppl. 01) 22-30.
• 37 Muhonen LH. et al. Serotonin transporter polymorphism as a predictor for escitalopram treatment of major depressive disorder comorbid with alcohol dependence. Psychiatry Res 2011; 186 (Suppl. 01) 53-7.
• 38 Johnson BA. et al. Topiramate for treating alcohol dependence: a randomized controlled trial. Jama 2007; 298 (Suppl. 14) 1641-51.
• 39 Addolorato G. et al. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet 2007; 370 9603 1915-22.
• 40 Beschluss des Gemeinsamen Bundesausschusses (G-BA) über eine Änderung der PsychotherapieRichtlinie: Präzisierung der Indikation, Abhängigkeit von Alkohol, Drogen oder Medikamenten“ und eine redaktionelle Änderung vom 14. April 2011. www.g-ba.de
• 41 Heffner JL. et al. Combining motivational interviewing with compliance enhancement therapy (MI-CET): development and preliminary evaluation of a new, manual-guided psychosocial adjunct to alcohol-dependence pharmacotherapy. J Stud Alcohol Drugs 2010; 71 (Suppl. 01) 61-70.
• 42 Vasilaki EI, Hosier SG, Cox WM. The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol Alcohol 2006; 41 (Suppl. 03) 328-35.
• 43 Loeber S, Mann K. Entwicklung einer evidenzbasierten Psychotherapie bei Alkoholismus – Eine Übersicht. Nervenarzt 2006; 77 (Suppl. 05) 558-66.
• 44 DGPPN B. KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW (Hrsg.) für die Leitliniengruppe Unipolare Depression. S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression-Langfassung. 1. Auflage. Berlin, Düsseldorf: DGPPN, ÄZQ, AWMF; 2009
• 45 Pilling S. et al. Diagnosis, assessment, and management of harmful drinking and alcohol dependence: summary of NICE guidance. Bmj 2011; 342: d700.