Verhaltensaktivierung durch SSRI als Gefahr für Amok-taten von Jugendlichen?

Zusammenfassung

Gegenstand und Ziel: Amoktäter sollen im Vorfeld der Tat eine depressive Symptomatik zeigen. Die vorliegende Arbeit widmet sich der Frage, ob durch eine medikamentöse Behandlung mit Antidepressiva, insbesondere mit selektiven Serotoninwiederaufnahme- Hemmern (SSRI), Aktivierungsphänomene, wie sie bei der medikamentösen Therapie der Depression bei Minderjährigen bekannt sind, auch bei Amokläufern ausgelöst werden? Methode: Systematische Literaturrecherche und Ergänzung durch weitere Studien zur Neurobiologie des serotonergen Systems bei suizidalen Patienten. Ergebnisse: Es liegt keine publizierte Untersuchung vor, die den Zusammenhang von antidepressiver Medikation und Amoktaten behandelt. Das Phänomen Verhaltensaktivierung bei Kindern und Jugendlichen unter SSRI ist gut belegt. Auch neurobiologische Untersuchungen zeigen, dass es Unterschiede im serotonergen System bei suizidalen Patienten gibt, je nachdem ob sie aggressive/impulsive oder weniger aggressive/ impulsive Suizidhandlungen planen oder verüben. Diskussion: Allein die Seltenheit der Ereignisse von Amoktaten erschwert aussagekräftige epidemiologische Untersuchungen, sodass ursächliche Zusammenhänge zwischen einer etwaigen Medikation und Taten bei diesem komplexen Geschehen schwer zu belegen sind. Klinische Relevanz: Bei einer Therapie mit Antidepressiva sollte bei entsprechenden Risikopatienten nicht nur bezüglich Suizidalität, sondern auch hinsichtlich fremdaggressiver Fantasien exploriert werden. Eine Kontraindikation für eine antidepressive Medikation stellen aggressive Tendenzen nach derzeitigem Kenntnisstand nicht dar. Die aggressiven Tendenzen bei entsprechenden Patienten sprechen eher für ein sorgfältiges Monitoring während der Therapie.

Summary

Objective: Depressive symptomatology has been observed in some school shooters. Does the treatment with antidepressants, especially with selective serotonin reuptake inhibitors (SSRI), lead to activation known from the pharmacological treatment of juvenile depression? Method: Systematic literature review with additional selective references regarding the neurobiology of the serotonergic system of suicidal patients. Results: To date no studies have been published about a link between antidepressant medication and school shootings. The phenomenon of behavioural toxicity in children and adolescents has been well described. Neurobiological findings show alterations in the serotonergic system of suicidal patients, depending on whether they are employing more or less aggressive/impulsive methods of suicide. Discussion: By virtue of a paucity of data (due to school shootings being rare events) there is hardly any evidence supporting a causal relationship between medication and school shootings. Clinically relevant points: Risk patients receiving antidepressant medication should be screened for aggressive phantasy. Based on the recent literature aggressive tendencies are no contraindication for antidepressant medication but they should lead to careful monitoring of these patients.

Schlüsselwörter

Amok - Antidepressiva - SSRI - Verhaltensaktivierung

Keywords

School shootings - antidepressants - SSRI - behavioural toxicity

• Literatur

• 1 Preti A, Cascio MT. Prison suicides and self-harming behaviours in Italy, 1990–2002. Med Sci Law 2006; 46 (02) 127-34.
• 2 Twemlow SW. et al. Premeditated mass shootings in schools: threat assessment. J Am Acad Child Adolesc Psychiatry 2002; 41 (04) 475-7.
• 3 Freud S. Das Ich und das Es. Studienausgabe Bd. III 1975; 4.
• 4 Petermann F, Döpfner M, Schmidt M. Aggressiv – dissoziale Störungen. Göttingen: Hogrefe Verlag; 2001
• 5 Center for Disease Control. Suicide attempts and physical fighting among High School students. MMWR, Morbidity and Morality Weekly Report 2004; 53 (22) 474-6.
• 6 Reuter-Rice K. Male adolescent bullying and the school shooter. J Sch Nurs 2008; 24 (06) 350-9.
• 7 Marohn RC. Management of the assaultive adolescent. Hosp Community Psychiatry 1992; 43 (06) 622-4.
• 8 Ilomaki E, Rasanen P, Viilo K, Hakko H. Suicidal behavior among adolescents with conduct disorder – the role of alcohol dependence. Psychiatry Res 2007; 150 (03) 305-11.
• 9 Harrington R. Depression, suicide and deliberate self-harm in adolescence. Br Med Bull 2001; 57: 47-60.
• 10 American College of Neuropsychopharmacology. Executive summary preliminary report of the tast force on SSRI and suicidal behavior in youth. January 21, 2004.
• 11 Nelson LS. et al. Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 2007; 45 (04) 315-32.
• 12 Statistisches Bundesamt. Statistisches Jahrbuch Wiesbaden. 2007
• 13 Salvatore S. Columbine shooter was prescribed anti-depressant. CNN interactive. 1999 20.04.2010; http://edition.cnn.com/HEALTH/9904/29/luvox.explainer
• 14 Kölch M, Fegert J. Medikamentöse Therapie der Depression bei Kindern und Jugendlichen. Praxis der Kinderpsychologie und Kinderpsychiatrie 2007; 56 (03) 224-33.
• 15 Hammad TA, Laughren T, Racoosin J. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 2006; 63 (03) 332-9.
• 16 Goodman WK, Murphy TK, Storch EA. Risk of adverse behavioral effects with pediatric use of antidepressants. Psychopharmacology (Berl) 2007; 191 (01) 87-96.
• 17 Murphy TK, Segarra A, Storch EA, Goodman WK. SSRI adverse events: how to monitor and manage. Int Rev Psychiatry 2008; 20 (02) 203-8.
• 18 Singh T, Prakash A, Rais T, Kumari N. Decreased use of antidepressants in youth after US Food and Drug Administration black box warning. Psychiatry (Edgmont) 2009; 06 (10) 30-4.
• 19 Exeter D, Robinson E, Wheeler A. Antidepressant dispensing trends in New Zealand between 2004 and 2007. Aust NZJ Psychiatry 2009; 43 (12) 1131-40.
• 20 Fergusson D. et al. Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. Bmj 2005; 330 7488 396.
• 21 Mosholder AD, Willy M. Suicidal adverse events in pediatric randomized, controlled clinical trials of antidepressant drugs are associated with active drug treatment: a meta-analysis. J Child Adolesc Psychopharmacol 2006; 16 (1–2): 25-32.
• 22 Mosholder AD, Pamer CA. Postmarketing surveillance of suicidal adverse events with pediatric use of antidepressants. J Child Adolesc Psychopharmacol 2006; 16 (1–2): 33-6.
• 23 Safer DJ, Zito JM. Treatment-emergent adverse events from selective serotonin reuptake inhibitors by age group: children versus adolescents. J Child Adolesc Psychopharmacol 2006; 16 (1–2): 159-69.
• 24 Dubicka B, Hadley S, Roberts C. Suicidal behaviour in youths with depression treated with new-generation antidepressants: meta-analysis. Br J Psychiatry 2006; 189: 393-8.
• 25 Bridge JA. et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. Jama 2007; 297 (15) 1683-96.
• 26 European Medicines Agency. Announcement of European Medicines Agency priorities for adverse drug reaction research. 2009
• 27 Henry C, Demotes-Mainard J. SSRIs, suicide and violent behavior: is there a need for a better definition of the depressive state?. Curr Drug Saf 2006; 01 (01) 59-62.
• 28 Walsh MT, Dinan TG. Selective serotonin reuptake inhibitors and violence: a review of the available evidence. Acta Psychiatr Scand 2001; 104 (02) 84-91.
• 29 Audenaert K. et al. Decreased frontal serotonin 5-HT 2a receptor binding index in deliberate selfharm patients. Eur J Nucl Med 2001; 28 (02) 175-82.
• 30 Audenaert K, Peremans K, Goethals I, van Heeringen C. Functional imaging, serotonin and the suicidal brain. Acta Neurol Belg 2006; 106 (03) 125-31.
• 31 Asberg M, Traskman L, Thoren P. 5-HIAA in the cerebrospinal fluid. A biochemical suicide predictor? Arch Gen Psychiatry 1976; 33 (10) 1193-7.
• 32 Fazel S, Grann M, Ahlner J, Goodwin G. Suicides by violent means in individuals taking SSRIs and other antidepressants: a postmortem study in Sweden, 1992–2004. J Clin Psychopharmacol 2007; 27 (05) 503-6.
• 33 Carlin Jr. NP, Hardisty R. SSRI-induced violent suicide: does forensic toxicology hold the answer?. J Clin Psychopharmacol 2008; 28 (04) 476-7.
• 34 Henriksson S, Boethius G, Isacsson G. Suicides are seldom prescribed antidepressants: findings from a prospective prescription database in Jamtland county, Sweden, 1985–95. Acta Psychiatr Scand 2001; 103 (04) 301-6.
• 35 Isacsson G, Holmgren P, Druid H, Bergman U. The utilization of antidepressants--a key issue in the prevention of suicide: an analysis of 5281 suicides in Sweden during the period 1992–1994. Acta Psychiatr Scand 1997; 96 (02) 94-100.
• 36 Gray D. et al. Utah youth suicide study, phase I: government agency contact before death. J Am Acad Child Adolesc Psychiatry 2002; 41 (04) 427-34.
• 37 Gray D, Moskos M, Keller T. Utah youth suicide study new findings. In: Annual meeting of the American Association of Suicidology. Sante Fe, New Mexico; 2003
• 38 Kessler RC. et al. Lifetime prevalence and age-ofonset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62 (06) 593-602.
• 39 Kessler RC. et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62 (06) 617-27.
• 40 Birmaher B. et al. Childhood and adolescent depression: a review of the past 10 years. Part I. J Am Acad Child Adolesc Psychiatry 1996; 35 (11) 1427-39.
• 41 Lewinsohn PM, Rohde P, Seeley JR. Psychosocial risk factors for future adolescent suicide attempts. J Consult Clin Psychol 1994; 62 (02) 297-305.
• 42 Essau CA, Petermann F, Conradt J. Depressive Symptome und Syndrome bei Jugendlichen. Z Klin Psychol Psychiatr Psychother 1996; 44 (02) 150-7.
• 43 Birmaher B. et al. Corticotropin-releasing hormone challenge in prepubertal major depression. Biol Psychiatry 1996; 39 (04) 267-77.
• 44 Costello EJ, Keeler GP, Angold A. Poverty, race/ethnicity, and psychiatric disorder: a study of rural children. Am J Public Health 2001; 91 (09) 1494-8.
• 45 Boyd CP. et al. Prevalence of anxiety and depression in Australian adolescents: comparisons with worldwide data. J Genet Psychol 2000; 161 (04) 479-92.
• 46 Doi Y, Roberts RE, Takeuchi K, Suzuki S. Multiethnic comparison of adolescent major depression based on the DSM-IV criteria in a U.S.-Japan study. J Am Acad Child Adolesc Psychiatry 2001; 40 (11) 1308-15.
• 47 Essau CA, Petermann U. Depression bei Kindern und Jugendlichen. Z Klin Psychol Psychopathol Psychother 1995; 43 (01) 18-33.
• 48 Simon GE, Savarino J. Suicide attempts among patients starting depression treatment with medications or psychotherapy. Am J Psychiatry 2007; 164 (07) 1029-34.
• 49 Brent DA. et al. Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI-resistant depression in adolescents (TORDIA) study. Am J Psychiatry 2009; 166 (04) 418-26.
• 50 Vitiello B. et al. Suicidal events in the treatment for adolescents with depression study (TADS). J Clin Psychiatry 2009; 70 (05) 741-7.
• 51 Vitiello B. et al. Depressive symptoms and clinical status during the treatment of adolescent suicide attempters study. J Am Acad Child Adolesc Psychiatry 2009; 48: 987-94.
• 52 Posner K. et al. Columbia suicide severity rating scale C-SSRS. In: 2Conte Center for the Neuroscience of Mental Disorders (CCNMD) New York: State Psychiatric Institute; 2007
• 53 Bridge JA. et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA 2007; 297 (15) 1683-96.
• 54 Allroggen M, Fegert JM. Narzisstische Störungen bei Jugendlichen und ihre Bedeutung bei der Einordnung von so genannten Trittbrettfahrern. Nervenheilkunde 2010; 29: 438-441.