Pharmakotherapie der ADHS im Erwachsenenalter

Zusammenfassung

Die Pharmakotherapie der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Erwachsenenalter ist in der multimodalen Behandlung dieser Erkrankung ein wichtiger Baustein. Für die medikamentöse Behandlung stehen verschiedene Präparate zur Verfügung, die seit vielen Jahren in der Behandlung von betroffenen Kindern und Jugendlichen zum Einsatz kommen. Die deutschen Leitlinien empfehlen auch für die medikamentöse Therapie der von ADHS betroffenen Erwachsenen Methylphenidat als Medikament erster Wahl. Metaanalysen konnten zeigen, dass die Effektstärke im Erwachsenenalter allerdings etwas geringer als im Kindesund Jugendalter ist. Es sind seit einigen Jahren verschiedene Methylphenidatpräparate mit unterschiedlicher Wirkstofffreisetzung und Wirkdauer auf dem Markt. Alternativ steht unter anderem das nicht betäubungsmittelrezeptpflichtige Atomoxetin zur Verfügung, das insbesondere bei begleitender Ticerkrankung oder Abhängigkeitserkrankung Vorteile aufweist. Bisher ist keine Substanz für die Behandlung Erwachsener zugelassen, d. h. die medikamentöse Behandlung erfolgt nach wie vor “off label”. Die bei vielen erwachsenen ADHS-Patienten bestehenden Komorbiditäten machen oft eine Kombinationsbehandlung z. B. mit Antidepressiva erforderlich.

Summary

The pharmacological treatment of attention deficit hyperactivity disorder (ADHD) in adults is an integral part of the multimodal treatment indicated in this disorder. There are different substances available which are intensively studied and highly efficacious in affected children and adolescents. The German Psychiatric guidelines recommend methylphenidate as drug of first choice also for the treatment of adults with ADHD. Metaanalyses could show though that the effect size in adults is smaller than in children (1.0 vs. 0.49). For several years now, various methylphenidate formulations with different kinetic profiles are on the market. Alternatively, atomoxetine which is not a narcotic, scheduled controlled prescription drug, is available. Atomoxetine might have advantages in treatment of ADHD patients with comorbide tic disorders or substance abuse. No pharmaceutical substance is licensed for treatment of ADHD in adults in Germany, the pharmacological treatment is completely “off label”. The very common comorbidities in adult ADHD patients often make a combined treatment, e. g. with antidepressants, necessary.

Schlüsselwörter

ADHS bei Erwachsenen - Pharmakotherapie - Stimulanzien - Atomoxetin

Keywords

ADHD in adults - psychopharmacological treatment - stimulants - atomoxetine

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