Sachs G S, Koslow C L, Ghaemi S N
Massachusetts General Hospital, Consolidated Department of Psychiatry, Harvard Medical School, Boston 02114, USA.
Bipolar Disord. 2000 Sep;2(3 Pt 2):256-60. doi: 10.1034/j.1399-5618.2000.20306.x.
The treatment of the depressed phase of bipolar disorder is understudied and remains a common clinical dilemma for clinicians. Compared to the manic phases, episodes of bipolar depression are more frequent and of longer duration, yet the literature on this problem is minimal. The few methodologically sound studies find that treatment effective for unipolar depression are also efficacious for bipolar depression. However, standard antidepressant agents may cause acute mania or a long-term worsening of bipolar illness. This paper reviews the available literature on the treatment of bipolar depression and offers recommendations for clinical management.
A literature search was conducted using keywords 'bipolar disorder', 'depression', 'drug therapy', 'antidepressants', 'lithium', and 'anticonvulsants'.
If effectively treated by lithium, patients are spared the risk of antidepressant-induced mania. If lithium is not sufficient treatment for acute depression, the combination of lithium and a standard antidepressant appears to reduce the risk of affective switch, as well as the induction of a long-term rapid-cycling course. Additionally, tapering antidepressant medication after periods of sustained remission can be beneficial in limiting the risk of affective switch and acceleration of the cycle rate.
Doctors must be cautious in prescribing antidepressants for bipolar depression. Use of antidepressants alone should be avoided.
双相情感障碍抑郁发作期的治疗研究较少，仍然是临床医生常见的临床难题。与躁狂发作期相比，双相抑郁发作更为频繁且持续时间更长，但关于这个问题的文献却很少。少数方法学上合理的研究发现，对单相抑郁有效的治疗方法对双相抑郁也有效。然而，标准抗抑郁药可能会引发急性躁狂或导致双相情感障碍病情长期恶化。本文回顾了关于双相抑郁治疗的现有文献，并为临床管理提供建议。
使用关键词“双相情感障碍”“抑郁”“药物治疗”“抗抑郁药”“锂盐”和“抗惊厥药”进行文献检索。
如果用锂盐有效治疗，患者可避免抗抑郁药诱发躁狂的风险。如果锂盐对急性抑郁治疗不足，锂盐与标准抗抑郁药联合使用似乎可降低情感转换风险以及诱发长期快速循环病程的风险。此外，在持续缓解一段时间后逐渐减少抗抑郁药用量，可能有助于降低情感转换风险和加快循环速度。
医生在为双相抑郁患者开抗抑郁药时必须谨慎。应避免单独使用抗抑郁药。
