Die prophylaktische Langzeitbehandlung affektiver Störungen mit Lithium, Valproat und Carbamazepin

Zusammenfassung

Die Public-Health-Relevanz phasischer affektiver Erkrankungen (Morbidität, Mortalität, Lebensqualität, Kosten) ist groß. Deshalb werden Therapiestudien mit Lithium, besonders zum Routineeinsatz der Substanz und zu Kostenaspekten im Überblick diskutiert. Aktuelle Übersichten bestätigen die prophylaktische Wirksamkeit von Lithium bei bipolaren affektiven Störungen. Allerdings ist die Lithiumresponserate im Routineeinsatz (effectiveness) niedriger als in kontrollierten Studien (efficacy). Non-Compliance ist ein wichtiger Grund dafür. In neueren Studien ist die Lithiumresponserate zudem wahrscheinlich aufgrund veränderter Diagnosegewohnheiten und eines breiteren Einsatzes niedriger. Therapieabbrüche unter Lithium begünstigen Rückfälle und erhöhen die Behandlungskosten. Deshalb kann Valproat hinsichtlich der Behandlungskosten Vorteile haben. Eine suizidpräventive Wirkung ist bislang nur für Lithium belegt. Für die optimale Nutzung des Lithiumpotenzials ist eine Complianceverbesserung wesentlich. In künftigen Studien müssen detailliertere Vergleiche zwischen Lithium, Valproat, Carbamazepin und neueren Behandlungsalternativen erfolgen.

Prophylactic Long-Term Therapy of Affective Disorders with Lithium, Valproic Acid and Carbamazepine - Effectiveness and Cost-Effectiveness

Affective disorders have a substantial public health impact due to morbidity, mortality, quality of life impairment and economic implications. There has been renewed debate of the efficacy and effectiveness of Lithium in long-term treatment of affective disorders. In the present paper current literature is discussed with a focus on the routine use of Lithium (effectiveness) and on cost aspects. Recent reviews have confirmed the prophylactic efficacy of Lithium in bipolar affective disorders. However, there is some evidence that effectiveness studies do not hold what efficacy research would promise. Non-compliance is likely to be a major reason for this. Lithium response rates have declined in recent studies. This may be related to diagnostic change (broader concept of affective disorders) and more widespread Lithium use. Non-compliance in patients taking Lithium is a primary factor in relapse with substantial cost effects (due to inpatient care). Current studies compare Lithium with Valproic acid/divalproex, and find cost advantages for the latter possibly due to better compliance. A special suicide-preventive effect has only been proven for Lithium. To ensure the full prophylactic potential of Lithium compliance needs to be improved. Future studies will compare Lithium with Valproic acid/divalproex, Carbamazepine and new treatment strategies more detailed.

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