Botts S R, Raskind J
College of Pharmacy and Allied Health Professions, St. John's University, Jamaica, NY 11439, USA.
Am J Health Syst Pharm. 1999 Oct 1;56(19):1939-44. doi: 10.1093/ajhp/56.19.1939.
The utility of gabapentin and lamotrigine for the treatment of bipolar disorder is reviewed. Bipolar disorder is characterized by extreme mood fluctuations, including mania, hypomania, depression, and mixed episodes. Extrapolation of postulated mechanisms of anticonvulsant activity in bipolar disorder has led to the use of the newer anticonvulsants gabapentin and lamotrigine for therapy. Both agents appear promising on the basis of limited (often anecdotal) evidence. They may prove effective in patients with difficult cases of bipolar disorder, such as patients with rapid cycling, mixed episodes, and illness refractory to other treatments. Lamotrigine may offer a much-needed treatment alternative for bipolar depression and could be found effective for acute mania, but the need for slow dosage adjustment and the risk of rash may limit overall clinical utility. Gabapentin may offer significant advantages for acute mania: The dosage can be adjusted rapidly, adverse effects are generally minimal, the therapeutic index is high, there is no required laboratory monitoring, and there is minimal potential for interactions with other psychotropics. Until the results of randomized controlled trials are known, however, these two agents should be reserved for patients with bipolar disorder unresponsive to traditional therapies and for patients who cannot tolerate traditional agents. Preliminary evidence indicates that gabapentin and lamotrigine may be useful for the treatment of bipolar disorder.
本文综述了加巴喷丁和拉莫三嗪治疗双相情感障碍的效用。双相情感障碍的特征是极端的情绪波动,包括躁狂、轻躁狂、抑郁和混合发作。基于双相情感障碍抗惊厥活性的假定机制推断,新型抗惊厥药加巴喷丁和拉莫三嗪已被用于治疗。基于有限的(通常是轶事性的)证据,这两种药物似乎都很有前景。它们可能对双相情感障碍的疑难病例有效,如快速循环型、混合发作型以及对其他治疗无效的患者。拉莫三嗪可能为双相抑郁提供急需的治疗选择,并且可能对急性躁狂有效,但需要缓慢调整剂量以及有皮疹风险可能会限制其整体临床效用。加巴喷丁对急性躁狂可能有显著优势:剂量可快速调整,不良反应通常最小,治疗指数高,无需实验室监测,与其他精神药物相互作用的可能性最小。然而,在随机对照试验结果出来之前,这两种药物应仅用于对传统疗法无反应的双相情感障碍患者以及不能耐受传统药物的患者。初步证据表明加巴喷丁和拉莫三嗪可能对双相情感障碍的治疗有用。