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Neurobiologie der Anhedonie

Zur Pathophysiologie eines bedeutenden Symptoms der depressiven Störung

The neurobiology of anhedonia

The pathophysiology of an important symptom in depressive disorders

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Zusammenfassung

Anhedonie – definiert als der Verlust der Fähigkeit, Freude zu empfinden, in Situationen, die früher Freude bereitet haben – ist ein wesentliches diagnostisches Merkmal der depressiven Störung. So stellt dieses Symptom gemäß den Kriterien der ICD-10 und des DSM-IV eines der drei Hauptsymptome der Erkrankung dar und ist somit für die Diagnose der depressiven Störung essenziell. In den letzten Jahren gelang es, anhand tierexperimenteller Studien und durch Projekte zur funktionellen Bildgebung, neue Erklärungsmodelle zur Pathophysiologie der Anhedonie zu entwickeln. Die Hypothese, dass funktionelle Veränderungen im mesolimbischen Belohnungssystem das neuronale Korrelat des Symptoms darstellen könnten, hat zu einem neuen Verständnis depressiver Störungen beigetragen und ermöglicht es, neue Therapieoptionen für bisher therapieresistente Fälle zu prüfen. Unter Einsatz der tiefen Hirnstimulation wird erprobt, ob sich die Anhedoniesymptomatik durch eine lokale und reversible Beeinflussung der neuronalen Aktivität in Strukturen des Belohnungssystems behandeln lässt. Der Artikel gibt einen kritischen Überblick über die Hintergründe dieser Therapieansätze und beleuchtet bisherige Ergebnisse der Studien.

Summary

The phenomenon of anhedonia, the inability to experience pleasure, is one of the essential elements for the diagnosis of depressive disorders. According to the criteria of both the ICD-10 and the DSM-IV, the presence of this symptom is crucial for the diagnosis of depressive disorders. In recent years scientific approaches using animal studies and projects of functional imaging have allowed the development of a new concept of the pathophysiology of anhedonia. The hypothesis that functional changes within the mesolimbic reward system could represent the neural correlate of anhedonia has contributed to a new concept of depressive disorders and allows testing of new therapeutic options for patients suffering from very resistant forms of depression. By using the method of deep brain stimulation present clinical studies try to ascertain whether the symptom of anhedonia can be alleviated by influencing the neural activity of the reward system. This article will give a critical overview about the background for new therapeutic approaches and illuminates the results of these studies.

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Interessenkonflikte

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehung hin: Forschungsförderung durch Medtronic Inc.

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Authors and Affiliations

  1. Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Würzburg, Würzburg, Deutschland

    S.R. Kuhlmann

  2. Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland

    H. Walter

  3. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland

    T.E. Schläpfer

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  1. S.R. Kuhlmann
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  2. H. Walter
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Correspondence to T.E. Schläpfer.

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Kuhlmann, S., Walter, H. & Schläpfer, T. Neurobiologie der Anhedonie. Nervenarzt 84, 590–595 (2013). https://doi.org/10.1007/s00115-012-3654-y

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