Bowden C L
Department of Psychiatry, University of Texas Health Science Center, San Antonio 78229-3900, USA.
Psychiatr Serv. 2001 Jan;52(1):51-5. doi: 10.1176/appi.ps.52.1.51.
Research over the past decade indicates that the prevalence of bipolar disorder is similar to that of major depression. The author discusses complexities in the diagnosis of bipolar disorder, especially in distinguishing bipolar from unipolar depression. Bipolar depression is associated with more mood lability, more motor retardation, and greater time spent sleeping. Early age of onset, a high frequency of depressive episodes, a greater percentage of time ill, and a relatively acute onset or offset of symptoms are suggestive of bipolar disorder rather than major depression. Because DSM-IV criteria require a manic or hypomanic episode for a diagnosis of bipolar disorder, many patients are initially diagnosed and treated as having major depression. Treatment of bipolar disorder with antidepressants alone is not efficacious and may exacerbate hypomania, mania, or cycling. It is important that clinicians be alert to any hint of bipolarity developing in the course of antidepressant therapy, especially among patients with first-episode major depression.
过去十年的研究表明，双相情感障碍的患病率与重度抑郁症相似。作者讨论了双相情感障碍诊断中的复杂性，尤其是区分双相情感障碍与单相抑郁症。双相抑郁症与更多的情绪不稳定、更多的运动迟缓以及更长的睡眠时间有关。发病年龄早、抑郁发作频率高、患病时间比例大以及症状相对急性发作或缓解提示为双相情感障碍而非重度抑郁症。由于《精神疾病诊断与统计手册》第四版标准要求有躁狂或轻躁狂发作才能诊断为双相情感障碍，许多患者最初被诊断并当作患有重度抑郁症进行治疗。仅用抗抑郁药治疗双相情感障碍无效，且可能会加重轻躁狂、躁狂或发作循环。临床医生必须警惕在抗抑郁治疗过程中出现双相情感障碍的任何迹象，尤其是在首发重度抑郁症患者中。
