Zusammenfassung
Die pharmakologische Behandlung der Depression ist trotz der enormen Fortschritte
der letzten 40 Jahre noch immer nicht zufrieden stellend. Alle derzeit verwendeten
Substanzen wirken über die Beeinflussung der Monoamine im zentralen Nervensystem.
In der vorliegenden Übersicht sollen neben Fortentwicklungen der monoaminergen Antidepressiva
neue antidepressive Wirkmechanismen vorgestellt und diskutiert werden. Neuere Entwicklungen
im Bereich der monoaminergen Substanzen umfassen Metabolite gängiger Antidepressiva,
direkte Serotoninagonisten oder Dreifachwiederaufnahmehemmer, die den Transport von
Serotonin, Noradrenalin und Dopamin hemmen. Bei den nicht monoaminergen Strategien
stehen Substanzen im Vordergrund, die auf Melatonin wirken oder Neuropeptide beeinflussen.
Eine hoffnungsvolle Klasse von möglichen Antidepressiva stellen die glutamat-modulierenden
Substanzen wie Ketamin und Riluzol dar. Daneben sind auch Fortschritte im Bereich
der Modulierung der HPA-Achse zu verzeichnen.
Abstract
Despite the advances in the psychopharmacology, the treatment of depressive disorder
is still not satisfactory. All current pharmacological substances are affecting the
monoamines in the central nervous system. The present review discusses advances in
the field of monoaminergic antidepressants as well as new treatment alternatives.
The new monoaminergic substances include metabolites of known antidepressants, direct
serotonin-agonists, and triple-reuptake inhibitors, blocking the transport of serotonin,
norepinephrine, and dopamine.
Non-monoaminergic strategies include substances affecting melatonin or neuropeptides.
Glutamate modulating agents such as ketamine or riluzole are another promising approach
in the treatment of depression. Some advances have also been achieved in the field
of HPA-axis modulation.
Schlüsselwörter
Depression - Antidepressiva - Medikamentenentwicklung
Key words
depression - antidepressants - drug discovery
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Dr. med. Helge Frieling
Psychiatrische und Psychotherapeutische Klinik Universitätsklinikum Erlangen
Schwabachanlage 6
91054 Erlangen
Email: helge.frieling@uk-erlangen.de
