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Gestuftes Vorgehen bei Resistenz gegen Antidepressiva-Therapie

  • H. Helmchen
Part of the Tropon-Symposium book series (BAYERZNS, volume 5)

Zusammenfassung

Für dieses Referat habe ich die umfangreiche Literatur der letzten 5 Jahre zum Thema aufgearbeitet. Als ich dann das daraus extrahierte Schema mit einem Stufenschema verglich, das ich vor 10 Jahren publiziert hatte, stellte ich zu meiner Überraschung fest, daß beide Schemata weitgehend übereinstimmten. Darauf habe ich mich gefragt, warum ein sachlich offenbar zutreffendes Schema so wenig die klinische Wirklichkeit beeinflußt hat, nicht einmal die eigene Klinik und auch nicht immer eigene therapeutische Entscheidungen. Die Antwort lautet: Bei der unübersehbaren Vielfalt der Entscheidungsmöglichkeiten kann die therapeutische Entscheidung im Einzelfall nur dann auf eine rationalere Basis gestellt werden, wenn sie einer regelmäßigen und standardisierten Response-Kontrolle folgt und jede - natürlich jederzeit mögliche - Abweichung vom Standard explizit begründet wird. Diesen beiden Prinzipien gegenüber sind alle Details und auch Unterschiede zwischen den zahlreichen Stufenschemata zur Depressionsbehandlung zweitrangig.

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  • H. Helmchen

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