Welche Behandlungsmethode/welche Medikamente/welche Therapie
wuerdet ihr bei Bipolar I vorschlagen?
Welche Behandlungsmethode/welche Medikamente/welche Therapie
wuerdet ihr bei Bipolar I vorschlagen?
hallo, nicole
eine kurze übersicht in englisch neuesten datums:
The treatment of bipolar depression is one of the conundrums of psychiatric practice. Although antidepressants are efficacious, lithium is increasingly being recommended as the first choice in non-psychotic, non-suicidal acute bipolar depression. If a patient is already on Lithium, Divalproex or Carbamazepine, dose optimization is the first step. If suicidality is a major concern, ECT should be considered early on in the algorithm of treatment choices. Cognitive behavioural and/or interpersonal therapy can be useful as adjuncts, particularly with patients who are able to actively participate in these therapies. In moderate to severe bipolar depression mood stabilizers may be combined with antidepressants or a second mood stabilizer or with lamotrigine or gabapentin. Antidepressants are effective in bipolar depression but there is little evidence that one is more efficacious than another. If psychotic features are present, the addition of a neuroleptic is advisable. Risperidone is increasingly commonly used. It is advisable to avoid a TCA, as these medications have the highest risk of switch into hypo/mania and induction of rapid cycling when compared with other antidepressants. Bupropion, which is available in Canada on an emergency drug release program, is reputed to present the least risk of switch into hypo/mania. However, this has not been systematically studied. Although antidepressants induce switch into hypo/mania and accelerate cycles only in a minority of patients, there is a concern that antidepressants interfere with achieving mood stability. If one uses an antidepressant, and the patients remains refractory to treatment, the usual augmentation strategies with antidepressants may be considered. ECT should also be considered at various points in the algorithm. Finally, the use of 3 mood stabilizers in combination or Clozapine may be considered in truly refractory situations. An essential and early component in management to deal with any alcohol and substance abuse which may be exacerbating the depression.
peter