Pharmakotherapie der ADHS im Erwachsenenalter bei komorbider Depression

 

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Zusammenfassung

Anliegen Die Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) hat aufgrund ihrer hohen Prävalenz von 2 - 6 % im Erwachsenenalter und der oft ausgeprägten klinischen Symptomatik große praktische Relevanz. Komorbide Störungen sind häufig. Methode Es wird ein Überblick über Diagnostik und differenzierte Pharmakotherapie der ADHS bei komorbider Depression gegeben. Ergebnisse und Schlussfolgerungen Die Depression hat als komorbide Störung bei ADHS hinsichtlich Differenzialdiagnostik und differenzierter Therapiekonzepte eine große klinische Bedeutung. Für die Kombination beider Erkrankungen gibt es gute psychotherapeutische und pharmakologische Behandlungsverfahren.

Abstract

Objective Attention-deficit/hyperactivity disorder (ADHD) is a common disorder with a high prevalence of 2 - 6 % in adults. The often distinctive clinical symptomatology has a great practical relevance and the diagnostic demarcation of other psychiatric illnesses can be difficult which underlines the necessity of a differential and careful diagnosis. ADHD is a risk factor for comorbid disorders like anxiety, personality disorders and addiction. Comorbid depression is also frequent and has an important meaning in the differential diagnostic process. Methods A review was made about diagnostics and pharmacotherapy of ADHD with comorbid depression. Results and Conclusions For the combination treatment of ADHD with comorbid depression there are good pharmacological procedures of treatment. Here in particular modern antidepressants with noradrenergic or noradrenergic-serotonergic active principles play an important role. Very important is an exact diagnosis and differentiated treatment of ADHD, i. e. a „multimodal therapy” using pharmacological and psychotherapeutic concepts.

Literatur

• 1 Barkley R A. Advancing age, declining ADHD.  Am J Psychiatry. 1997;  154 1323-1325
  PubMedGoogle Scholar
• 2 Wender P H. Attention-deficit disorder in adults. New York; Oxford University Press 1995
  Google Scholar
• 3 Kessler R C, Adler L, Barkley R. et al . The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication.  Am J Psychiatry. 2006;  163 716-723
  Google Scholar
• 4 Faraone S V, Biederman J. Neurobiology of attention-deficit hyperactivity disorder.  Biol Psychiatry. 1998;  44 951-958
  CrossrefPubMedGoogle Scholar
• 5 Smalley S L, Bailey J N, Palmer C G. et al . Evidence that the dopamine D4 receptor is a susceptibility gene in attention deficit hyperactivity disorder.  Mol Psychiatry. 1998;  3 427-430
  CrossrefPubMedGoogle Scholar
• 6 Ernst M, Zametkin A J, Matochik J A, Jons P H, Cohen R M. DOPA decarboxylase activity in attention deficit hyperactivity disorder adults. A [fluorine-18] fluorodopa positron emission tomographic study.  J Neurosci. 1998;  18 5901-5907
  PubMedGoogle Scholar
• 7 Dougherty D D, Bonab A A, Spencer T J, Rauch S L, Madras B K, Fischman A J. Dopamine transporter density in patients with attention deficit hyperactivity disorder.  Lancet. 1999;  354 2132-2133
  CrossrefPubMedGoogle Scholar
• 8 Dresel S HJ, Kung M P, Huang X F, Plössl K, Hou C, Meegalla S K, Patselas G. et al . Simultaneous SPECT studies of pre- and postsynaptic dopamine binding sites in baboons.  J Nucl Med. 1999;  40 660-666
  PubMedGoogle Scholar
• 9 Krause K H, Dresel S H, Krause J, Kung H F, Tatsch K, Ackenheil M. Stimulant-like action of nicotine on striatal dopamine transporter in the brain of adults with attention deficit hyperactivity disorder.  Int J Neuropsychopharmacol. 2002;  5 111-113
  PubMedGoogle Scholar
• 10 Gainetdinov R R, Wetsel W C, Jones S R, Levin E D, Jaber M, Caron M G. Role of serotonin in the paradoxical calming effect of psychostimulants on hyperactivity.  Science. 1999;  283 397-401
  CrossrefPubMedGoogle Scholar
• 11 Edel M A, Schmidt K. Phobische Angst und Persönlichkeitsstörungen sowie soziale Beeinträchtigung ambulanter erwachsener Patienten mit Aufmerksamkeitsdefizit/Hyperaktivitätsstörungen.  Nervenheilkunde. 2003;  22 415-418
  PubMedGoogle Scholar
• 12 Biederman J, Faraone S V, Keenan K. et al . Further evidence for family-genetic risk factors in attention deficit hyperactivity disorder. Patterns of comorbidity in probands and relatives psychiatrically and pediatrically referred samples.  Arch Gen Psychiatry. 1992;  49 728-738
  PubMedGoogle Scholar
• 13 Krause J, Krause K H. ADHS im Erwachsenenalter. Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Erwachsenen. Stuttgart, New York; Schattauer 2005
  Google Scholar
• 14 Biederman J, Faraone S V, Spencer T. et al . Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder.  Am J Psychiatry. 1993;  150 1792-1798
  PubMedGoogle Scholar
• 15 MTA Cooperative Group . A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD.  Arch Gen Psychiatry. 1999;  56 1073-1086
  Google Scholar
• 16 Hesslinger B, Tebartz van Elst L, Mochan F, Ebert D. A psychopathological study into the relationship between attention deficit hyperactivity disorder in adult patients and recurrent brief depression.  Acta Psychiatr Scand. 2003;  107 385-389
  CrossrefPubMedGoogle Scholar
• 17 Spencer T J. Our new understanding of the prevalence, impairments, comorbidity and treatment of adults with ADHD. 157th Annual Meeting,. New York; American Psychiatric Association 2004
  Google Scholar
• 18 Elia J, Ambrosini P J, Rapoport J L. Treatment of attention-deficit-hyperactivity disorder.  N Engl J Med. 1999;  340 780-788
  CrossrefPubMedGoogle Scholar
• 19 Wilens T E. Drug therapy for adults with attention-deficit hyperactivity disorder.  Drugs. 2003;  63 2395-2411
  CrossrefPubMedGoogle Scholar
• 20 Barrickman L, Noyes R, Kuperman S, Schumacher E, Verda M. Treatment of ADHD with fluoxetine: a preliminary trial.  J Am Acad Child Adolesc Psychiatry.. 1991;  30 762-767
  PubMedGoogle Scholar
• 21 Schulz S C. Atypicals in borderline personality disorders. 157th Annual Meeting. New York; American Psychiatric Association 2004
  Google Scholar
• 22 Adler L A, Resnick S, Kunz M, Devinsky O. Open-label trial of venlafaxine in adults with attention deficit disorder.  Psychopharmacol Bull. 1995;  31 785-788
  PubMedGoogle Scholar
• 23 Findling R L, Schwartz M A, Flannery D J, Manos M J. Venlafaxine in adults with attention-deficit/hyperactivity disorder: an open clinical trial.  J Clin Psychiatry. 1996;  57 184-189
  PubMedGoogle Scholar
• 24 Hornig-Rohan M, Amsterdam J D. Venlafaxine versus stimulant therapy in patients with dual diagnosis ADD and depression.  Prog Neuropsychopharmacol Biol Psychiatry. 2002;  26 585-589
  CrossrefPubMedGoogle Scholar
• 25 Wilens T E, Biederman J, Mick E, Spencer T J. A systematic assessment of tricyclic antidepressants in the treatment of adult attention-deficit hyperactivity disorder.  J Nerv Ment Dis. 1995;  183 48-50
  PubMedGoogle Scholar
• 26 Wilens T E, Biederman J, Prince J. et al . Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder.  Am J Psychiatry. 1996;  153 1147-1153
  PubMedGoogle Scholar
• 27 Wilens T E, Spencer T J, Biederman J. et al . A controlled clinical trial of bupropion for attention deficit hyperactivity disorder in adults.  Am J Psychiatry. 2001;  158 282-288
  CrossrefPubMedGoogle Scholar
• 28 Kuperman S, Perry P J, Gaffney G R. et al . Bupropion SR vs. methylphenidate vs. placebo for attention deficit hyperactivity disorder in adults.  Ann Clin Psychiatry. 2001;  13 129-134
  CrossrefPubMedGoogle Scholar
• 29 Michelson D, Allen A J, Busner J. et al . Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: a randomized, placebo-controlled study.  Am J Psychiatry. 2002;  159 1896-1901
  CrossrefPubMedGoogle Scholar
• 30 Michelson D, Faries D, Wernicke J. et al . Atomoxetine ADHD Study Group. Atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled, dose-response study.  Pediatrics. 2001;  108 E83
  CrossrefPubMedGoogle Scholar
• 31 Spencer T, Biederman J, Heiligenstein J, Wilens T, Faries D, Prince J, Faraone S V, Rea J, Witcher J, Zervas S. An open-label, dose-ranging study of atomoxetine in children with attention deficit hyperactivity disorder.  J Child Adolesc Psychopharmacol. 2001;  11 251-265
  CrossrefPubMedGoogle Scholar
• 32 Kratochvil C J, Newcorn J H, Arnold L E, Duesenberg D, Emslie G J, Quintana H, Sarkis E H, Wagner K D, Gao H, Michelson D, Biederman J. Atomoxetine alone or combined with fluoxetine for treating ADHD with comorbid depressive or anxiety symptoms.  J Am Acad Child Adolesc Psychiatry. 2005;  44 915-924
  CrossrefPubMedGoogle Scholar

Dr. med. Martin D. Ohlmeier

Abteilung Klinische Psychiatrie und Psychotherapie, Medizinische Hochschule Hannover

Carl-Neuberg-Straße 1

30625 Hannover

Email: ohlmeier.martin@mh-hannover.de