Bipolare Depression

Zusammenfassung

Depressive Episoden und subsyndromale depressive Zuständen prägen maßgeblich den Verlauf bipolarer Erkrankungen und sind bestimmend für die hohe Morbidität und Mortalität dieser Störung. Klinische und epidemiologische Charakteristika können hilfreich sein, die richtige diagnostische Einordnung eines depressiven Syndroms vorzunehmen: Ein frühes Ersterkrankungsalter, Angehörige 1. Grades mit einer bipolaren Störung, eine rasche Entwicklung der depressiven Symptomatik sowie deren schnelles Abklingen, eine komorbide Angstoder Suchterkrankung und Symptome einer atypischen Depression sind bei bipolaren Depressionen deutlich häufiger anzutreffen als bei unipolaren Patienten. Die Behandlung sollte zunächst immer mit einem antidepressiv wirksamen Stimmungsstabilisierer erfolgen. Antidepressiva sind bei bipolaren Depressionen nur eingeschränkt effektiv und bergen in sich das Risiko einer Manieinduktion und Phasenbeschleunigung. Allerdings scheint dieser Effekt für bestimmte Antidepressivagruppen wie Trizyklika deutlich ausgeprägter zu sein als etwa für SSRI. Auch nicht medikamentöse Verfahren wie Schlafentzug und Elektrokonvulsionsbehandlung sind effektiv bei der Behandlung der bipolaren Depression ebenso wie der Einsatz von störungsspezifischen Psychotherapieformen.

Summary

Depressive episodes as well as subsyndromal depressive symptoms dominate the course of bipolar disorder and are highly associated with the high morbidity and mortality of this disease. Clinical and epidemiologic characteristics can be helpful for the adequate diagnostic classification of a depressive syndrome: An early age at onset, first grade relatives presenting bipolar disorder, rapid onset of depressive symptomatology, comorbidity with an anxiety disorder or substance abuse as well as symptoms of atypical depression are significantly more frequent in bipolar depressive patients than in unipolar patients. Treatment of bipolar depression should always be initiated with an antidepressive effective mood stabilizer. Antidepressants show only limited benefits in bipolar depression and hold the risk of induction of mania or cycle acceleration. However, this phenomena seems to be more pronounced in specific groups of antidepressants like tricyclics than for example in SSRI´s. Other non-pharmacological, biological treatments like sleep deprivation and electroconvulsive therapy are also highly effective in treating bipolar depression as well as the implementation of disorder specific psychotherapeutic treatments.

Schlüsselwörter

Bipolare Depression - Differenzialdiagnose - Stimmungsstabilisierer

Keywords

Bipolar depression - differential diagnosis - mood stabilizer

• Literatur

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