40 Jahre Beta-Blocker in der Psychiatrie

 

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Zusammenfassung

Beta-Blocker gehören zu den erfolgreichsten Substanzklassen der Medizin. Meist werden sie in der Inneren Medizin eingesetzt. In der Psychiatrie wurden Beta-Blocker erstmals vor 40 Jahren bei Angstpatienten angewandt. Seitdem wurde die Wirksamkeit von Beta-Blockern bei schizophrenen und manischen Psychosen, bei vegetativen Entzugssymptomen und bei aggressiven Verhaltensstörungen untersucht. Ebenso werden Beta-Blocker bei unerwünschten Wirkungen von Psychopharmaka, wie Neuroleptika- oder Antidepressiva-induzierten Tachykardien, Lithium-induziertem Tremor, Neuroleptika-induzierter Akathisie sowie bei Spätdyskinesien eingesetzt. Seit Mitte der 90er Jahre wurden Augmentationsstrategien einer antidepressiven Pharmakotherapie mit dem serotonerg wirksamen Beta-Blocker Pindolol entwickelt. Traumatische Gedächtnisinhalte werden unter noradrenerger Aktivierung vermutlich vermehrt gespeichert. Aus diesem Grund wird der lipidlösliche, die Bluthirnschranke gut passierende Beta-Blocker Propranolol seit einigen Jahren bei Patienten mit posttraumatischer Belastungsstörung (PTSD) versuchsweise eingesetzt. Basierend auf einer umfassenden Literaturübersicht diskutiert der vorliegende Artikel sämtliche Indikationen für Beta-Blocker im Bereich der Psychiatrie. Unter Berücksichtigung evidenzbasierter Leitlinienaspekte sind Beta-Blocker beim Lithium-induzierten Tremor, bei Neuroleptika-induzierter Akathisie und bei aggressivem Verhalten von Patienten mit hirnorganischen Störungen indiziert.

Abstract

Beta-adrenoceptor blockers belong to the most successful drug classes of medicine. Mainly they are used in internal medicine. 40 years ago beta-adrenoceptor blockers have occasionally been used in psychiatry for the treatment of anxiety disorders. Over the past four decades, the effects of beta-adrenoceptor blockers in the treatment of schizophrenic and manic psychoses, withdrawal syndromes and aggressive behaviour with temper outbursts has been investigated. Beta-adrenoceptor blockers are also used in the treatment of side-effects of psychopharmacological agents like neuroleptic or antidepressant-induced tachycardias, lithium-induced tremor, antipsychotic-induced akathisia or tardive dyskinesia as well. Since the mid-nineties it has been attempted to improve the efficacy of antidepressant agents by means of the 5-HT-_1a-receptorantagonist pindolol. Presumedly memory consolidation of traumatic events can be enhanced by adrenergic activation. Therefore some open clinical trials investigated the effects of propranolol, a lipid soluble drug, which crosses the blood-brain barrier easily, to reduce the manifestation of PTSD. The present review presents the results of the literature with respect to the indications for beta-blockers in psychiatry. Considering evidence-based-medicine criteria beta-blockers are indicated to treat lithium-induced tremor, antipsychotic-induced akathisia and to reduce aggressive behavior of patients with brain-injuries.

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Dr. Jürgen Kornischka

Klinik für Psychiatrie, Psychotherapie & Psychosomatik am Klinikum Herford Akademisches Lehrkrankenhaus der Medizinischen Hochschule Hannover

Schwarzenmoorstr. 70

32049 Herford

Email: juergen.kornischka@klinikum-herford.de