Aufkommende Suizidgedanken einer bipolaren Patientin nach Einnahme von Pregabalin: ein Fallbericht

Zusammenfassung

Die bipolare Störung ist eine schwere psychische Erkrankung, die häufig mit Komorbiditäten wie Angst oder Alkoholabhängigkeit vergesellschaftet ist. Somit könnte der Einsatz von Pregabalin vielversprechend sein. Wir präsentieren den Fallbericht einer 37jährigen Frau mit einer Bipolar II Störung während einer depressiven Episode begleitet von Angstsymptomen und zunehmendem Alkoholkonsum. Die medikamentöse Behandlung bestand aus einer Monotherapie mit Quetiapin. Nach einigen Tagen mit zusätzlicher Gabe von Pregabalin beobachteten wir zunehmende Suizidgedanken sowie selbstverletzendes Verhalten, obwohl die Angstsymptome und der Alkoholkonsum rückläufig waren. Wir beendeten die Therapie mit Pregabalin und erhöhten die Dosis von Quetiapin, hierauf verschwand das suizidale Verhalten fast vollständig. Ein Blick in die Literatur zeigt noch Uneinigkeit. Einerseits wird Pregabalin als sicheres und gut toleriertes Medikament beschrieben und andererseits bestehen Bedenken hinsichtlich suizidaler Effekte antikonvulsiver Medikamente. Schlussfolgernd empfehlen wir den vorsichtigen Einsatz von Pregabalin sowie weiterer antikonvulsiver Medikamente bei Patienten mit affektiven Störung. Pregabalin könnte einen positiven Effekt auf die Komorbiditäten haben, der Effekt auf die Stimmung verbleibt jedoch noch unklar.

Abstract

Bipolar disorder is a severe mental illness and often occurs with comorbidities like anxiety or alcohol abuse. Thus pregabalin could be a promising drug. We present a case report of a 37-year-old woman with bipolar II disorder suffering from a depressive episode with features of anxiety and increased alcohol consumption. The patient was started on quetiapine as monotherapy. After a few days of add-on pregabalin, we observed suicidal ideations and self-harming behaviour, although expression of anxiety as well as alcohol consumption showed a decrease. When we stopped pregabalin and increased the dosage of quetiapine, suicidal behaviour almost disappeared. In the relevant literature, there is disagreement on the use of pregabalin. On the one hand, pregabalin is described as a safe and well-tolerated drug, and on the other hand, there are also concerns about the suicidal effect of anticonvulsants. In conclusion, we recommend the cautious use of pregabalin and other anticonvulsant drugs in patients with affective disorder. There could be a promising effect on the comorbidities but the effect on mood remains still unclear.

Schlüsselwörter

Bipolare Störung - Generalisierte Angststörung - Alkoholabhängigkeit - Pregabalin - Antikonvulsiva - Suizidgedanken

Keywords

Pregabalin - anxiety disorder - anticonvulsant - alcohol abuse - suicidal ideation - bipolar disorder

Publication History

Received: 17 November 2019

Accepted after revision: 21 July 2024

Article published online:
29 August 2024

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