Kleindienst N, Greil W
Psychiatric Hospital of the University of Munich, Germany.
Neuropsychobiology. 2000;42 Suppl 1:2-10. doi: 10.1159/000054844.
In a randomized clinical trial with an observation period of 2.5 years, the differential efficacy of lithium versus carbamazepine was compared in 171 bipolar patients (DSM-IV). In order to investigate the efficacy of the two drugs in clearly defined subsamples, a series of subgroup analyses was carried out. First, patients with a bipolar I disorder (n = 114) were analyzed separately. In these patients, lithium was superior to carbamazepine. In contrast, carbamazepine was at least equally as efficacious as lithium in the subsample of patients with bipolar II disorder or bipolar disorder not otherwise specified (n = 57). In a second analysis on differential efficacy, the whole sample was subdivided into a classical subgroup (bipolar I patients without mood-incongruent delusions and without comorbidity; n = 67) and a nonclassical subgroup including all other patients (n = 104). Classical bipolar patients had a significantly lower hospitalization rate under lithium than under carbamazepine prophylaxis (26 vs. 62%, p = 0.012). For the nonclassical group, a tendency in favor of carbamazepine was found. In a third step, we analyzed the impact of episode sequence on differential efficacy. In a global view, the episode sequence prior to the index episode was not correlated to differential efficacy. Our results might, however, indicate that patients with an episode sequence of mania-depression-free interval responded better to lithium. Besides differential efficacy, suicidal behavior and patients' satisfaction with treatment were investigated. Regarding suicidal behavior, a trend in favor of lithium was found. The data on patients' satisfaction were significantly in favor of carbamazepine. In conclusion, lithium appears to be superior to carbamazepine in classical bipolar cases and might have additional impact on proneness to suicide. The distinctly larger group of patients with nonclassical features might profit more from carbamazepine which seems to be well accepted by the patients. Hence, treatment alternatives to lithium are desirable for the majority of bipolar patients.
在一项为期2.5年的随机临床试验中，对171例双相情感障碍患者（DSM-IV）比较了锂盐与卡马西平的疗效差异。为了研究这两种药物在明确界定的亚组中的疗效，进行了一系列亚组分析。首先，对114例双相I型障碍患者进行了单独分析。在这些患者中，锂盐优于卡马西平。相比之下，在双相II型障碍或未另行规定的双相情感障碍患者亚组（n = 57）中，卡马西平至少与锂盐疗效相当。在第二项疗效差异分析中，将整个样本分为经典亚组（无心境不一致性妄想且无合并症的双相I型患者；n = 67）和包括所有其他患者的非经典亚组（n = 104）。经典双相情感障碍患者在接受锂盐预防时的住院率显著低于接受卡马西平预防时（26%对62%，p = 0.012）。对于非经典组，发现有倾向于卡马西平的趋势。第三步，我们分析了发作顺序对疗效差异的影响。从总体来看，索引发作前的发作顺序与疗效差异无关。然而，我们的结果可能表明，有躁狂-抑郁无间歇发作顺序的患者对锂盐反应更好。除了疗效差异外，还调查了自杀行为和患者对治疗的满意度。关于自杀行为，发现有倾向于锂盐的趋势。患者满意度数据显著支持卡马西平。总之，在经典双相情感障碍病例中，锂盐似乎优于卡马西平，并且可能对自杀倾向有额外影响。具有非经典特征的明显更大的患者群体可能从卡马西平中获益更多，而卡马西平似乎为患者所接受。因此，对于大多数双相情感障碍患者来说，需要有锂盐之外的治疗选择。
