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CC BY-NC-ND 4.0 · Fortschr Neurol Psychiatr
DOI: 10.1055/a-2182-5365
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Psychopharmakotherapie mit dem MAO-Hemmer Tranylcypromin Schwerpunkte und Trends aus Theorie und Praxis

Psychopharmacotherapy with the MAO-inhibitor Tranylcypromine Key Aspects and Trends in Theory and Practice
Sven Ulrich
1   Med.-wiss. Abt., Aristo Pharma GmbH, Berlin, Germany
,
Ute Lewitzka
2   Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland, Dresden, Germany
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Zusammenfassung

Der irreversible Monoaminoxidase-Hemmer Tranylcypromin ist seit mehr als 60 Jahren als Antidepressivum bekannt. Ziel dieses Übersichtsartikels ist die Bestimmung des Standes der Wissenschaft und Therapie von Tranylcypromin. Dafür wird die aktuelle Fachliteratur ausgewertet und hinsichtlich gegenwärtiger Schwerpunkte und allgemeiner Trends der praktischen Psychopharmakotherapie eingeordnet. Im Ergebnis kann Tranylcypromin heute durch neue Metaanalysen kontrollierter Studien als gut etabliert für die Behandlung der therapieresistenten Depression gelten. Die Dosierung (Maximaldosis, Erhaltungsdosis) wird zunehmend für Anforderungen der therapieresistenten Depression angepasst. Die Monoaminoxidase ist nicht nur primäre pharmakologische Zielstruktur von Tranylcypromin sondern bestimmt zu Therapiebeginn als arzneistoffmetabolisierendes Enzym enantioselektiv auch die Pharmakokinetik des Monoaminoxidase-Hemmers. Mit zunehmender Diversität der antidepressiven Pharmakotherapie ist eine fortwährende Zuordnung von Tranylcypromin als therapeutische „ultima ratio“ bei Depression überdenkenswert. Es wird geschlussfolgert, dass Tranylcypromin als Mittel der zweiten Wahl eine wertvolle Option der antidepressiven Therapie bleibt. Die Kriterien für eine Umstellung von anderen Antidepressiva auf den Monoaminoxidase-Hemmer müssen noch besser definiert werden.

Abstract

The irreversible monoamine oxidase inhibitor tranylcypromine has been known as an antidepressant drug for more than 60 years. The aim of this review was to make an assessment of the state of the art and therapy of tranylcypromine. The recent medical-scientific literature is analyzed and discussed with respect to key aspects of and general trends in practical psychopharmacotherapy. Meta-analyses of controlled clinical studies have shown that tranylcypromine is an established approach to treatment-resistant depression. Doses (maximum dose, maintenance dose) are increasingly adapted to the requirements of treatment-resistant depression. Monoamine oxidase is not only the primary pharmacological target of tranylcypromine but determines for the first doses also the pharmacokinetics of tranylcypromine because monoamine oxidase is also an enantioselective drug-metabolizing enzyme of the monoamine oxidase inhibitor. An increased diversity of the antidepressant pharmacotherapy suggests the need to rethink the continuing assessment of tranylcypromine as a therapeutic “ultima ratio” in depression. In conclusion, tranylcypromine as a drug of second choice remains a valuable option in antidepressant treatment. Criteria of a switch from other antidepressant drugs to tranylcypromine should be better defined.

Schlüsselwörter

Tranylcypromin - MAO-Hemmer - Depression - Monoaminoxidase - Tyramin

Key words

tranylcypromine - MAO-inhibitor - depression - monoamine oxidase - tyramine


Publication History

Received: 30 December 2022

Accepted: 17 August 2023

Article published online:
21 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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