Download PDF
Nervenheilkunde 2009; 28(05): 293-297
DOI: 10.1055/s-0038-1628635
Thema zum Schwerpunkt
Schattauer GmbH

Umstellung und Kombinationen von Antidepressiva

Was lernen wir aus der Star-D-Studie?Adjustment and combination of antidepressantsWhat can we learn from the Star-D report
U Voderholzer
1   Abteilung für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg
› Author Affiliations
Further Information

Publication History

Eingegangen am: 02 March 2009

angenommen am: 18 March 2009

Publication Date:
23 January 2018 (online)

    Permissions and Reprints

Zusammenfassung

Depressive Erkrankungen können heute effektiv mit Psychotherapie und mit Antidepres-siva behandelt werden. Dennoch sprechen nicht alle Patienten auf die Behandlung an. Bei fehlendem Ansprechen auf eine Behand-lungsstrategie wird nach bekannten Leitlinien empfohlen, auf eine andere Behandlung, z. B. auf ein anderes Medikament oder eine Kom-bination von Medikamenten umzustellen. Die vorliegende Arbeit befasst sich mit der gegenwärtigen wissenschaftlichen Evidenz für den therapeutischen Nutzen der Umstellung von einem Antidepressivum auf ein anderes Antidepressivum, beziehungsweise auf eine Kombination aus zwei Antidepressiva im Falle einer Non-Response auf ein Antidepressivum. Die Wirksamkeit psychotherapeutischer Behandlungen ist nicht Gegenstand dieser Arbeit.

Summary

Today, depressive disorders can be treated effectively with psychotherapy and antidepres-sants, but not every treated patient with depression is a responder. In the case of nonre-sponders, guidelines recommend a new adjustment or a combination therapy. This article gives an overview about recent medical evidence of the therapeutic benefit of an adjustment from one antidepressant to another or a combination therapy with two antidepressants in case of a nonresponse to one antidepressant. The effectiveness of psychotherapy in general is not discussed here.

Schlüsselwörter

Antidepressiva - Switching - Kombinationstherapie - Depression - affektive Störungen - Therapieresistenz

Keywords

Antidepressants - switching - combination treatment - depressive disorder - affective disorder - treatment refractory
 

  • Literatur

  • 1 Adli M. et al. Algorithms for optimizing the treatment of depression: making the right decision at the right time. Pharmacopsychiatry 2003; 36 Suppl 3 222-229.
    Google Scholar
  • 2 AHCPR (Agency of Health Care Policy and Research): Evidence report on treatment of depression. Newer Pharmacotherapies AHCPR pub. 1999; No. 99–E014.
    Google Scholar
  • 3 Anderson IM. Selective serotonin reuptake inhibitors versus tricyclic antidepressant: a meta-analysis of efficacy and tolerability. J Affect Disord 2000; 58 (01) 19-36.
    CrossrefPubMedGoogle Scholar
  • 4 Anderson IM. Meta-analytical studies on new antidepressants. Br Med Bull 2001; 57: 161-178.
    CrossrefPubMedGoogle Scholar
  • 5 Arroll B. et al. Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: a meta-analysis. Ann Fam Med 2005; 03 (05) 449-456.
    CrossrefPubMedGoogle Scholar
  • 6 Bauer M. Review: electroconvulsive therapy may be ab effective short therm treatment for people with depression. Evid Based Ment Health 2003; 06 (03) 83.
    CrossrefPubMedGoogle Scholar
  • 7 Cipriani A. et al. Comparative efficacy and acceptability of 12 new-generation multiple-treatments meta-analysis. Lancet 2009; 373: 746-758.
    CrossrefPubMedGoogle Scholar
  • 8 Corya SA. et al. A randomized, double-blind comparison of olanzapine/fluoxetine combination, olanzapine, fluoxetine, and venlafaxine in treatment-resistant depression. Depress Anxiety 2006; 23 (06) 364-372.
    CrossrefPubMedGoogle Scholar
  • 9 Fava M. et al. A Comparison of mirtazapine and nortriptyline following two consecutive failed medication treatments for depressed outpatients: A STAR*D report. Am J Psychiatry 2006; 163 (07) 1161-1172.
    CrossrefPubMedGoogle Scholar
  • 10 Ferreri M. et al. Benefits from mianserin augmentation of fluoxetine in patients with major depression non-responders to fluoxetine alone. Acta Psychiatr Scand 2001; 103 (01) 66-72.
    CrossrefPubMedGoogle Scholar
  • 11 Fochtmann JL, Alan J. Gelenberg. Guideline Watch: Practice guideline for the treatment of patients with major depressive disorder. 2nd edition. APA Practice Guidelines; 2005
    Google Scholar
  • 12 Gaebel W, Falkai P. DGPPN Behandlungsleitlinie Affektive Erkrankungen. 2000
    PubMedGoogle Scholar
  • 13 Gartlehner G. et al. Comparative benefits and harms of second-generation antidepressants: Background paper for the American College of Physicians. Ann Intern Med 2008; 149 (10) 734-750.
    CrossrefPubMedGoogle Scholar
  • 14 Hansen RA. et al. Efficacy and safety of second-generation antidepressants in the treatment of major depressive disorder. Ann Intern Med 2005; 143 (06) 415-426.
    CrossrefPubMedGoogle Scholar
  • 15 Hirschfeld RM. Efficacy of SSRIs and newer antidepressants in severe depression: comparison with TCAs. J Clin Psychiatry 1999; 60 (05) 326-335.
    CrossrefPubMedGoogle Scholar
  • 16 Kirsch I. et al. Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine 2008; 05 (02) e45.
    CrossrefPubMedGoogle Scholar
  • 17 Lam RW. et al. Combining versus switching in patients with treatment-resistant depression. J Clin Psychiatry 2004; 65 (03) 337-340.
    CrossrefPubMedGoogle Scholar
  • 18 Lenox-Smith AJ, Jiang Q. Venlafaxine extended release versus citalopran in patients with depression unresponsive to al selective serotonin reuptake inhibitor. International Clinical Psychopharmacol-ogy 2008; 23 (03) 113-119.
    CrossrefPubMedGoogle Scholar
  • 19 Mottram P, Wilson K, Strobl J. Antidepressants for depressed elderly. Cochrane Database Syst Rev. 2006 25. (1) CD 003491.
    PubMedGoogle Scholar
  • 20 Nierenberg AA, McColl RD. Management options for refractory depression. Am J Med 1996; 101 6A 45S-52S.
    CrossrefPubMedGoogle Scholar
  • 21 Papakostas GI, Fava M, Thase M. Treatment of SSRI-resistant depression: A meta-analysis comparing within- versus across-class switches. Biol Psychiatry 2008; 63 (07) 699-704.
    CrossrefPubMedGoogle Scholar
  • 22 Rockville, Depression in primary Care Vol.2 Treatment of major depression. US Dept. of Health and Human Services, AHCPR Publication No.93–0550. 1993
    PubMedGoogle Scholar
  • 23 Ruhé HG. et al. Switching antidepressants after a first selective serotonin reuptake inhibitor in major depressive disorder. A systematic review J Clin Psychiatry 2006; 67 (12) 1836-1855.
    PubMedGoogle Scholar
  • 24 Rush AJ. et al. Acute and long-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR*D Report. Am J Psychiatry 2006; 163 (11) 1905-1917.
    CrossrefPubMedGoogle Scholar
  • 25 Schmauss M, Messer T. Augmentation strategies for therapy resistant depression – a review. Psychiatr Prax 2007; 34 (04) 165-174.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Shelton RC. et al. Olanzapine/fluoxetine combination for treatment-resistant depression: a controlled study of SSRI and nortriptyline resistance. J Clin Psychiatry 2005; 66 (10) 1289-97.
    CrossrefPubMedGoogle Scholar
  • 27 Thase M. et al. Double-blind switch study of imipramine or sertraline treatment of antidepressant-resistant chronic depression. Arch Gen Psychiatry 2002; 59 (03) 233-9.
    CrossrefPubMedGoogle Scholar
  • 28 Thase ME. et al. Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: A STAR*D report. Am J Psychiatry 2007; 164 (05) 739-752.
    CrossrefPubMedGoogle Scholar
  • 29 Warden D. et al. The STAR*D Project results: A comprehensive review of findings. Current Psychiatry Reports 2007; 09 (06) 449-459.
    CrossrefPubMedGoogle Scholar
  • 30 McGrath PJ. et al. Tranylcypromine versus Venlafaxine plus Mirtazapine following three failed antidepressant medication trials for depression: A STAR*D report. Am J Psychiatry 2006; 163: 1531-1541.
    CrossrefPubMedGoogle Scholar