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Akut- und Langzeittherapie der bipolaren Depressionen

Acute and long-term treatment for bipolar depression

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Zusammenfassung

Bipolare Depressionen gehen mit erheblichen seelischen Belastungen und einem hohen Suizidrisiko einher; dies macht eine rasche und wirksame Therapie dringend erforderlich. Allerdings gilt auch bei der bipolaren Depression, ähnlich wie bei der Maniebehandlung, die langfristige Prophylaxe schon zu Therapiebeginn im Auge zu behalten. Bei vergleichbarer Wirksamkeit sollten Medikamente mit einem guten Sicherheits- und Verträglichkeitsprofil in jedem Fall den Vorzug erhalten. Zusätzliche Psychotherapie kann sowohl die kurz- als auch langfristige Prognose bipolarer Depressionen deutlich verbessern. Die Elektrokonvulsionstherapie (EKT) hat unverändert ihren Platz bei schweren, therapieresistenten bipolaren Depressionen. Während die EKT in der Hand spezialisierter Zentren liegt, ist die korrekte Diagnosestellung und medikamentöse sowie psychotherapeutische Behandlungseinleitung vorrangige Aufgabe von Haus- und Nervenärzten.

Summary

Bipolar depression is linked with substantial burden and a high suicide risk, making a rapid and highly efficacious treatment mandatory. However, similar to mania, aspects of long-term treatment should already be considered at treatment initiation. With comparable efficacy, drugs with a beneficial safety and tolerability profile should be preferred. Additional psychotherapy can also noticeably improve both short- and long-term outcome of bipolar depression. Electroconvulsive therapy (ECT) still has its place in severe, treatment-resistant bipolar depression. Whereas ECT is a domain of specialised centres, correct diagnosis and both pharmacological and psychotherapeutic treatment initiation are essential tasks of primary care practitioners and secondary care psychiatrists.

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Danksagung

Die Autoren bedanken sich bei Frau Heike Brosamler für ihre sekretarielle Unterstützung.

Interessenkonflikt

Der korrespondierende Autor weißt auf folgende Beziehungen: Prof. Dr. Grunze ist als Referent oder Berater für die Firmen Astra Zeneca, BMS, Eli Lilly, Glaxo-SmithKline, Janssen-Cilag, Organon, Pfizer Inc, Sanofi-Aventis, Servier und UBC tätig. Er erhält Drittmittel für Auftragsforschung oder Forschungsunterstützung von Astra Zeneca, Bial, UK National Institute for Mental Health Research, Pfizer Inc, und The Stanley Research Institute.

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Authors and Affiliations

  1. Institute of Neuroscience, Psychiatry, Newcastle University, RVI, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK

    H. Grunze

  2. Psychiatrische Klinik der LMU München, München, Deutschland

    S. Dargel

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Correspondence to H. Grunze.

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Grunze, H., Dargel, S. Akut- und Langzeittherapie der bipolaren Depressionen. Nervenarzt 81, 539–548 (2010). https://doi.org/10.1007/s00115-009-2851-9

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