Pharmakologische Therapie manisch-depressiver Mischzustände

S. Krüger; P. Bräunig

doi:10.1055/s-0038-1627170

Nervenheilkunde, Table of Contents

Nervenheilkunde 2008; 27(03): 145-154
DOI: 10.1055/s-0038-1627170

Original- und Übersichtsarbeiten - Original and Review Articles

Schattauer GmbH

Pharmakologische Therapie manisch-depressiver Mischzustände

Pharmacotherapy of manic-depressive mixed states

Authors

S. Krüger

¹Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Campus Mitte
P. Bräunig

²Klinik für Psychiatrie, Humboldt Klinikum Vivantes, Berlin

Abstract

Zusammenfassung

Hintergrund: Manisch-depressive Mischzustände kommen in 40% aller akuten bipolaren Episoden vor. Es handelt sich um komplexe, schwer zu behandelnde klinische Bilder. In diesem Beitrag soll ein Überblick über die Literatur zur Therapie der Mischzustände gegeben werden. Methode: Die Literatur wurde anhand von Medline-, Embase- und Cochrane-Controlled-Trials-Register-Suche identifiziert. Ergebnisse: Es fanden sich sehr wenige doppelblinde, placebokontrollierte Studien, die sich speziell mit der Therapie manisch-depressiver Mischzustände beschäftigen. Stattdessen sind Patienten mit Mischzuständen oftmals eine Untergruppe der untersuchten Gesamtkohorte. Die verfügbaren Daten zeigen, dass akute Mischzustände nicht günstig auf Lithium ansprechen. Stattdessen sind Valproat und Olanzapin die Medikamente der ersten Wahl. Antidepressiva sollten vermieden werden, weil sie das intraepisodische Switching dieser Episoden verstärken können. Lamotrigin kann bei Mischzuständen mit überwiegend depressiven Symptomen eingesetzt werden. Schlussfolgerungen: Es sind mehr Studien nötig, die sich speziell mit der Therapie manisch-depressiver Mischzustände befassen. Behandlungsempfehlungen können nur vorläufig sein, weil die Datenlage eine definitive Therapieempfehlung zum jetzigen Zeitpunkt nicht zulässt.

Summary

Objective: Mixed episodes comprise up to 40% of acute bipolar admissions. They are difficult to treat, complex clinical pictures. This review provides an overview of the available literature on the pharmacotherapy of manic-depressive mixed states and suggests treatment options. Method: Literature was identified by searches in Medline, Embase and the Cochrane Controlled Trials Register. Results: Overall, there were very few double-blind, placebo-controlled studies specifically designed to treat manic-depressive mixed states. Rather, patients with mixed states comprised a subgroup of the examined patient cohorts. Nevertheless, the data show that acute mixed states do not respond favourably to lithium. Instead, valproate and olanzapine are drugs of first choice. Carbamazepine may play a role in the prevention of mixed states. Antidepressants should be avoided, because they may worsen intraepisodic mood lability. Lamotrigine may be useful in treating mixed states with predominantly depressive symptoms. Conclusions: More treatment studies specifically designed to treat the complex clinical picture of mixed states are clearly needed. Current treatment recommendations for clinical practice based on the available literature can only target selected aspects of these episodes.

Schlüsselwörter

Mischzustand - Diagnostik - Therapie - Valproinsäure - Olanzapin - Lithium - Antidepressiva

Keywords

Mixed state - diagnosis - treatment - valproate - olanzapine - lithium - antidepressan

Full Text

References

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