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Themenschwerpunkt

Pharmakotherapie bei ADHS im Erwachsenenalter: Eine Bestandsaufnahme

Published Online:March 06, 2015https://doi.org/10.1024/1661-4747/a000215

Abstract

Nimmt man heute, im Zeitalter der evidenzbasierten Medizin (EBM), Leitlinien als Maßstab für die medikamentöse Therapie der ADHS im Erwachsenenalter, so hat sich in den vergangenen 10 Jahren wenig verändert: Methylphenidat ist weiterhin auf Platz Nr. 1 und Medikament der ersten Wahl. Einige vielversprechende und in den USA zugelassene Substanzen sind bei uns weiterhin off-label, beziehungsweise im Zulassungsverfahren blockiert. Doch es besteht die berechtigte Hoffnung, dass sich in den kommenden Jahren etwas bewegen wird. Bis zu 80 % der ADHS-Betroffenen haben Komorbiditäten sowohl im psychischen als auch im somatischen Bereich. Aus diesen Gründen ist es hilfreich, wenn mit den neuen Substanzen «zwei Fliegen mit einer Klappe» behandelt werden können, zum Beispiel ADHS und soziale Phobien beziehungsweise ADHS und komorbider Alkoholmissbrauch mit Atomoxetin. Die Erweiterung des pharmakologischen Armamentariums ist auch deshalb dringend notwendig, weil ADHS-Betroffene dank Internet und Chatrooms maßgeschneiderte Lösungen, unbesehen der Vorgaben von EBM, für sich suchen und fordern. Die Integration der medikamentösen Behandlung in einen multimodalen Ansatz entspricht dem heutigen Goldstandard.


Pharmacotherapy of ADHD in adults: A Survey

In the current age of evidence-based medicine (EBM), taking guidelines as a measuring stick for drug therapy in adult ADHD shows that not much has changed in the past 10 years: methylphenidate is still number one and first-line treatment. Here, some promising drugs available in the US are still off-label or stuck in the admission process, but there’s hope that something will move in coming years. Up to 80 % of individuals with ADHD have both psychic and somatic comorbidities. It is therefore helpful if new drugs can treat “two birds with one stone”, e. g. atomoxetine for ADHD and social phobia, or ADHS and comorbid alcohol abuse. The expansion of the therapeutic armamentarium is urgent also for the reason that individuals with ADHD look to the internet and chat rooms for tailored solutions to their problems, independently of EBM guidelines. The integration of drug treatment into a multimodal approach represents today's gold standard.

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