Ausgabe 12/ 2009, S. 38
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Fortbildung | CME Psychiatrie

Patienten mit Major Depression

Wer wird auf das Antidepressivum ansprechen?

Ömür Baskaya, Stefanie Wagner, Klaus Lieb und André Tadic, Mainz

Die Major Depression (MD) ist eine schwere, hoch prävalente, häufig chronisch oder episodisch verlaufende lebenslange Erkrankung. Epidemiologische Studien in Europa und in den USA zeigen, dass die unipolare Depression mit einer Lebenszeit-und Zwölfmonatsprävalenz von bis zu 16,8% bzw. 6,6% die häufigste psychische Erkrankung in der Allgemeinbevölkerung ist [1, 2]. Unipolare depressive Störungen gehören weltweit konstant zu den am meisten behindernden Erkrankungen. Im Jahr 1990 waren sie die vierthäufigste Ursache von sog. Disability Adjusted Life Years (DALYs), einem Maß für die Belastung durch Erkrankungen, Verletzungen und Risikofaktoren, basierend auf der Anzahl der Lebensjahre, die aufgrund vorzeitigem Tod verloren wurden (engl. Years of Life Lost Due to Premature Mortality, YLL), und auf der Anzahl der Lebensjahre, die mit weniger als der vollständigen Gesundheit gelebt wurden (engl. Years of Life Lived in Less than Full Health, YLD). Für unipolare depressive Störungen prognostizierte die Weltgesundheitsorganisation (WHO), dass sie die zweithäufigste Ursache der DALYs im Jahr 2020 sein werden [3]. Weiter produzieren Depressionen erhebliche Kosten durch Krankenhausaufnahmen, ambulante Behandlung und Produktivitätsverlust als Folge depressionsassoziierter Morbidität, Suizide und anderer relevanter Parameter. Für Europa wurden die durch Depressionen verursachten jährlichen Kosten im Jahr 2004 auf 118 Milliarden Euro geschätzt. Dies macht sie zur teuersten Hirnerkrankung in Europa [4].

Korrespondenzadresse
Dr. med. Ömür Baskaya
Klinik für Psychiatrie und Psychotherapie,
Universitäts medizin der Johannes Gutenberg-Universität
Mainz, Untere Zahlbacher Str. 8, D-55131 Mainz
Tel.: 06131/17-6111, Fax: 06131/17-6490
E-Mail: baskaya@psychiatrie.klinik.uni-mainz.de

Literatur

  1. Alonso J, Angermeyer MC, Bernert S, et al. Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project, Acta Psychiatr Scand Suppl 2004; 420: 47-54.
  2. Kessler RC, Berglund P, Demler O, et al. National Comorbidity Survey Replication: The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003, 289: 3095-3105.
  3. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006, 3: e442.
  4. Sobocki P, Jönsson B, Angst J, et al. Cost of depression in Europe. J Ment Health Pol Economics 2006, 9: 87-98.
  5. Turner EH, Matthews MA, Linardatos E, et al. Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy. N Engl J Med 2008; 358: 252-60.
  6. Kirsch I, Deacon BJ, Huedo-Medina TB, et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 2008; 5(2):e45.
  7. Bauer M, Bschor T, Pfennig A, et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders in Primary Care. World J Biol Psychiatry 2007; 8: 67-104.
  8. Arzneimittelkommission der deutschen Ärzteschaft. Empfehlungen zur Therapie der Depression. 2. Auflage, Arzneiverordnung in der Praxis 2006: 33, Sonderheft 1.
  9. Montgomery SA, Baldwin DS, Blier P, et al. Which antidepressants have demonstrated superior efficacy? A review of the evidence. Int Clin Psychopharmacol. 2007;22:323-329.
  10. Einarson TR. Evidence based review of escitalopram in treating major depressive disorder in primary care. Int Clin Psychopharmacol. 2004;19:305-310.
  11. Anderson IM. SSRIS versus tricyclic antidepressants in depressed inpatients: a meta-analysis of efficacy and tolerability. Depress Anxiety. 1998;7:11-17.
  12. Davidson JR, Meoni P, Haudiquet V, Cantillon M, Hackett D. Achieving remission with venlafaxine and fluoxetine in major depression: its relationship to anxiety symptoms. Depress Anxiety. 2002; 16:4-13.
  13. Bakish D. The patient with comorbid depression and anxiety: the unmet need. J Clin Psychiatry. 1999; 60(suppl 6):20-24.
  14. Joyce PR, Paykel ES. Predictors of drug response in depression. Arch Gen Psychiatry. 1989;46:89-99.
  15. Nierenberg AA, Farabaugh AH, Alpert JE, et al. Timing of onset of antidepressant response with fluoxetine treatment. American Journal of Psychiatry 2000, 157: 1423-8.
  16. Posternak MA, Zimmerman M. Is there a delay in the antidepressant effect? A meta-analysis. J Clin Psychiatry 2005; 66: 148-58.
  17. Papakostas GI, Perlis RH, Scalia MJ, et al. A meta-analysis of early sustained response rates between antidepressants and placebo for the treatment of major depressive disorder. J Clin Psychopharmacology 2006; 26: 56-60.
  18. Taylor MJ, Freemantle N, Geddes JR, et al. Early onset of selective serotonin reuptake inhibitor antidepressant action: systematic review and meta-analysis. Arch Gen Psychiatry 2006; 63: 1217-23.
  19. Stassen HH, Angst J, Hell D, et al. Is there a common resilience mechanism underlying antidepressant drug response? Evidence from 2848 patients. J Clin Psychiatry 2007; 68: 1195-1205.
  20. Szegedi A, Müller MJ, Anghelescu I, et al. Early improvement under mirtazapine and paroxetine predicts later stable response and remission with high sensitivity in patients with major depression. J Clin Psychiatry 2003; 64: 413-20.
  21. Szegedi A, Jansen WT, van Willigenburg AP, et al. Early improvement as a predictor of treatment outcome in patients with major depressive disorder: Why the first 2 weeks really matter-evidence from 6,562 patients. J Clin Psychiatry 2009; 70: 344-53.
  22. Tadi? A, Helmreich I, Mergl R, et al. Early improvement is a predictor of treatment outcome in patients with mild major, minor or subsyndromal depression. J Affect Disord 2009; doi: 10.1016/j.jad.2009.04.014.
  23. van Calker D, Zobel I, Dykierek P, et al. Time course of response to antidepressants: predictive value of early improvement and effect of additional psychotherapy. J Affect Disord 2008; doi:10.1016/j.jad.200807.023.
  24. Keller F, Hautzinger M. Klassifikation von Verlaufskurven in der Depressionsbehandlung. Z Klin Psychol Psychother 2007; 36, 83-92.
  25. Henkel V, Seemüller F, Obermeier M, et al. Does early improvement triggered by antidepressants predict response/remission? - analysis of data from a naturalistic study on a large sample of inpatients with major depression. J Affect Disord 2008;doi:10.1016/j.jad.2008.10.011.
  26. Hennings JM, Owashi T, Binder EB, et al. Clinical characteristics and treatment outcome in a representative sample of depressed inpatients - findings from the Munich Antidepressant Response Signature (MARS) project. J Psychiatr Res 2009;43:215-29.
  27. Beblo T, Baumann B, Bogerts B, et al. Neuropsychological Correlates of Major Depression: A Short-term Follow-up. Cognitive Neuropsychiatry 1999; 4: 333-41.
  28. De Groot MH, Nolen WA, Huijsman AM, et al. Lateralized neuropsychological functioning in depressive patients before and after drug therapy. Biol Psychiatry 1996; 40: 1282-7.
  29. Gorlyn M, Keilp JG, Grunebaum MF, et al. Neuropsychological characteristics as predictors of SSRI treatment response in depressed subjects. J Neural Transm 2008; 115: 1213-9.
  30. Neu P, Bajbouj M, Schilling A, et al. Cognitive function over the treatment course of depression in middle-aged patients: correlation with brain MRI signal hyperintensities. J Psychiatr Res 2005; 39: 129-32.
  31. Kampf-Sherf O, Zlotogorski Z, Gilboa A, et al. Neuropsychological functioning in major depression and responsiveness to selective serotonin reuptake inhibitors antidepressants. J Affect Disord. 2004; 82: 453-459
  32. Gorlyn M, Keilp JG, Grunebaum MF, et al. Neuropsychological characteristics as predictors of SSRI treatment response in depressed subjects. J Neural Transm. 2008; 115: 1213-1219
  33. Mössner R, Mikova O, Koutsilieri E, et al. Consensus paper of the WFSBP Task Force on Biological Markers: biological markers in depression. World J Biol Psychiatry. 2007; 8: 141-74.
  34. Holsboer F. How can we realize the promise of personalized antidepressant medicines? Nat Rev Neurosci 2008;9: 638-46.
  35. Sen S, Duman R, Sanacora G. Serum brain-derived neurotrophic factor, depression, and antidepressant medications: meta-analyses and implications. Biol Psychiatry 2008; 64: 527-32.
  36. Brunoni AR, Lopes M, Fregni F. A systematic review and meta-analysis of clinical studies on major depression and BDNF levels: implications for the role of neuroplasticity in depression. Int J Neuropsychopharmacol 2008; 11: 1169-80.
  37. Thase ME. Depression, sleep, and antidepressants. J Clin Psychiatry. 1998; 59 (suppl 4): 55-65.
  38. Knott VJ, Telner JI, Lapierre YD, et al. Qantitative EEG in the prediction of antidepressant response to imipramine. J Affect Disord 1996; 39:175-84.
  39. Yatham LN, Liddle PF, Dennie J, et al. Decrease in brain serotonin 2 receptor binding in patients with major depression following desipramine treatment: a positron emission tomography study with fluorine-18-labeled setoperone. Arch Gen Psychiatry 1999; 56: 705-11.
  40. Sargent PA, Kjaer KH, Bench CJ, et al. Brain serotonin1A receptor binding measured by positron emission tomography with [11C]WAY-100635: effects of depression and antidepressant treatment. Arch Gen Psychiatry 2000; 57: 174-180.
  41. Kegeles LS, Malone KM, Slifstein M, et al. Response of cortical metabolic deficits to serotonergic challenge in familial mood disorders. Am J Psychiatry 2003; 160: 76-82.