Die selektiven Serotonin-Wiederaufnahmehemmer und die neueren Antidepressivasubstanzen in der Kinder- und Jugendpsychiatrie
Abstract
Zusammenfassung:Fragestellung: Seit der ersten Publikation über einen selektiven Serotonin-Wiederaufnahmehemmer (SSRI) 1974 kam es nicht nur zur Weiterentwicklung der Wirkstoffe aus der Gruppe der SSRI, sondern es sind auch neue Substanzgruppen entwickelt worden. Zu diesen neueren Substanzgruppen gehören, gegliedert nach dem pharmakologischen Wirkmechanismus, die Serotonin2-Antagonisten/Serotonin-Wiederaufnahmehemmer (SARI), die noradrenergen und selektiv serotonergen Antidepressiva (NaSSA), die Noradrenalin- und Dopamin-Wiederaufnahmehemmer (NDRI) und die Serotonin- und Noradrenalin-Wiederaufnahmehemmer (SNRI). In dieser Übersichtsarbeit werden die Wirkmechanismen und Nebenwirkungssprofile der neuen Antidepressivasubstanzen dargestellt und mit den älteren Substanzgruppen wie trizyklischen Antidepressiva (TZA), MAO-Hemmern (MAOH) und SSRI verglichen. Es werden Studien mit Antidepressiva bei Kindern und Jugendlichen mit Depression vorgestellt und verglichen, ob es Unterschiede zwischen den älteren und neueren Antidepressiva gibt. Methode: Es wurde eine Medline Recherche bis einschließlich Januar 2002 durchgeführt. Schlussfolgerungen: Die bis jetzt durchgeführten Studien mit den neueren Antidepressiva sind vielversprechend. Allerdings sind weitere doppelblind, Placebo-kontrollierte Studien notwendig.
Ergebnisse: Es gibt drei doppelblind, Placebo-kontrollierte Studien mit SSRI und eine doppelblind, Placebo-kontrollierte Studie mit dem neueren Antidepressivum Venlafaxin bei Kindern und Jugendlichen mit Depression. Es gibt allerdings eine Vielzahl von prospektiven und retrospektiven Studien. Weiterhin gibt es sieben doppelblind, Placebo-kontrollierte Studien mit SSRI und einige prospektive und retrospektive Studien mit den neueren Antidepressivsubstanzen bei Kindern und Jugendlichen mit anderen psychiatrischen Störungen. Summary:Objectives: Since the first report on a selective serotonin reuptake inhibitor (SSRI) in 1974, not only have new substances in the group of the SSRI been developed, but also completely new groups of antidepressants. Among these newer groups, characterised by their pharmacological properties, are the serotonin2-antagonists/serotonin reuptake inhibitors (SARI), the noradrenergic and specific serotonergic antidepressants (NaSSA), the noradrenaline and dopamine reuptake inhibitors (NDRI) and the serotonin and noradrenaline reuptake inhibitors (SNRI). This review describes the properties and side effects of the newer antidepressants and compares them to those of the older substance groups like tricyclic antidepressants (TCA), MAO inhibitors (MAOI) and SSRI. Studies of antidepressants in children and adolescents with depression are presented and compared for differences between the older and newer substances. Methods: A Medline search was performed up to and including January 2002. Results: Three double-blind, placebo-controlled studies of SSRI and one double-blind, placebo-controlled study of the newer antidepressant venlafaxine in children and adolescents with depression have been conducted. However, there is a great number of prospective and retrospective studies. Furthermore, seven double-blind, placebo-controlled studies of SSRI, as well as several prospective and retrospective of the newer antidepressants have been carried out in children and adolescents with other psychiatric disorders. Conclusions: The studies of the SSRI and the newer antidepressants conducted to date are promising. Nonetheless, further double-blind, placebo-controlled studies are necessary.
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