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Adjuvante Schilddrüsen-Hormonbehandlung bei therapieresistenten affektiven Störungen

  • M. Bauer
Conference paper

Zusammenfassung

  1. 1.

    Verschiedene Befunde lassen einen Zusammenhang zwischen Dysfunktionen der Hypothalamus-Hypophysen-Schilddrüsen (HPT)-Achse und affektiven Störungen vermuten. So findet sich z. B. eine subklinische Hypothyreose gehäuft bei Patienten mit refraktärer Depression bzw. bei bipolaren Patienten mit schnellem Phasenwechsel (Rapid Cycling) sowie ein Absinken der Schilddrüsenhormone im Serum unter der Therapie mit Antidepressiva, ein Effekt, der mit der klinischen Wirksamkeit korreliert.

     
  2. 2.

    Aufgrund dieser Zusammenhänge wurde wiederholt untersucht, ob Schilddrüsenhormone sowohl in der Akutbehandlung therapieresistenter depressiver Patienten als auch in der Behandlung prophylaxere-sistenter manisch-depressiver Patienten von therapeutischem Nutzen sind.

     
  3. 3.

    Studien zur niedrig dosierten Trijodthyronin (T3)-Zugabe zu einem Antidepressivum (sogenannte T3-Augmentation) erbrachten teilweise widersprüchliche Ergebnisse. Eine Literaturübersicht zeigt eine Responserate von etwa 50 % bei therapieresistenten depressiven Patienten.

     
  4. 4.

    Mit Hilfe einer adjuvanten hochdosierten L-Thyroxin (T4)-Therapie (bis 500 μg/d) kann ein Rapid Cycling bei bipolaren Psychosen gestoppt werden. Ergebnisse aus offenen Studien lassen den Schluß zu, daß T4 hochdosiert in Kombination mit Standardtherapeutika wie z. B. Lithium oder Carbamazepin bei Patienten mit refraktärem bipolaren Verlauf phasenprophylaktisch wirkt.

     
  5. 5.

    Erste Ergebnisse einer Pilotstudie zur Frage der antidepressiven Wirkung einer adjuvanten hochdosierten L-Thyroxin-Therapie(300–600 μg/d) zeigen eine Remissionsrate von ca. 40 % bei Patienten mit therapieresistenter Depression. Möglicherweise gibt es eine Subpopulation therapierefraktärer depressiver Patienten, die auf eine hochdosierte T4-Therapie anspricht.

     

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© Springer-Verlag Berlin Heidelberg 1997

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  • M. Bauer

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