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Depressionen bei Abhängigkeitserkrankungen

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Akute und therapieresistente Depressionen

Zusammenfassung

Lebenszeitprävalenzen für depressive Störungen nach DSM- und ICD-Kriterien liegen bei alkoholabhängigen Patienten zwischen 54 und 75%, bei opiatabhängigen Patienten werden zwischen 38 und 56% angegeben. Für die Behandlung therapieresistenter Depressionen bei Patienten mit einer Substanzabhängigkeit ist bezüglich der diagnostischen Einteilung wichtig, inwieweit es sich um unabhängig voneinander bestehende Erkrankungen handelt.

Häufig erlaubt erst die Stabilisierung der Suchterkrankung eine konsequente Therapie der affektiven Störungen. Therapiekonzepte für eine depressive Störung sollten daher prinzipiell die Abhängigkeitserkrankung direkt miteinbeziehen. Eine ausreichend lange Abstinenzbehandlung, psychoedukative Suchtgruppen, die Einbindung in Selbsthilfegruppen, eine medikamentöse Rückfall- prophylaxe mittels Acamprosat und bei opiatabhängigen Patienten in Einzelfällen eine suffiziente Substitutionsbehandlung stellen die wesentlichen Therapiepfeiler eigenständig verlaufender Abhängigkeitserkrankungen dar. — Sekundäre Depressionen remittieren zumeist spontan nach ausreichend langer Abstinenzzeit. Der Hauptgrund für andauernde therapieresistente sekundäre Depressionen ist hier ein weiterhin bestehender Sub- stanzmissbrauch.

Im Fall einer eigenständig verlaufenden Depression unterscheidet sich das therapeutische Vorgehen letztendlich nicht grundlegend von dem Vorgehen bei depressiven Patienten ohne Suchterkrankung. In der medikamentösen antidepressiven Therapie haben neuere Antidepressiva bezüglich der Leberverträglichkeit gerade bei Alkoholabhängigkeit ein günstigeres Nebenwirkungsprofil als trizyklische Antidepressiva. Bei der Anwendung augmentativer Strategien (z. B. Lithium) sowie einer medikamentösen phasenprophylaktischen Behandlung (z. B. Lithium, Carbamazepin, Valproinsäure und Lamotrigin) sind ebenfalls Besonderheiten der Leberverträglichkeit zu beachten. Bei komorbiden Patienten sollte zudem eine möglicherweise eingeschränkte Zuverlässigkeit bei der Medikamenteneinnahme mit möglichen Komplikationen (z. B. Lithium) in Betracht gezogen werden. Letztendlich kann bei andernfalls therapieresistenter Depression die Elektrokrampftherapie, insbesondere wegen der guten Verträglichkeit, eine sinnvolle Therapieoption sein. Intensivierte psychotherapeutische Angebote sollten gerade komorbiden Patienten angeboten werden.

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Authors
  1. M. Schäfer
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  2. A. Heinz
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Editors and Affiliations

  1. Klinik für Psychatrie und Psychotherapie, Charité — Universitätsklinik Berlin, Campus Charité Mitte (CCM), Schumannstr. 20/21, 10117, Berlin

    Michael Bauer  & Mazda Adli  & 

  2. Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité — Universitätsklinik Berlin, Campus Charité Mitte (CCM), Luisenstr. 57, 10117, Berlin

    Anne Berghöfer

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© 2005 Springer Medizin Verlag Heidelberg

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Schäfer, M., Heinz, A. (2005). Depressionen bei Abhängigkeitserkrankungen. In: Bauer, M., Berghöfer, A., Adli, M. (eds) Akute und therapieresistente Depressionen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-28049-9_7

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  • DOI: https://doi.org/10.1007/3-540-28049-9_7

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-40617-4

  • Online ISBN: 978-3-540-28049-1

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