Erfurth Andreas, Michael Nikolaus, Stadtland Cornelis, Arolt Volker
Department of Psychiatry, Münster University Hospital, Germany.
Neuropsychobiology. 2002;45 Suppl 1:33-6. doi: 10.1159/000049259.
Bupropion, a selective norepinephrine and dopamine reuptake inhibitor, has been suggested for the treatment of bipolar depression, not only because of its efficacy, but also because of a probably lower risk of inducing switches to hypomania or mania. Most studies on bupropion treatment in bipolar patients have been performed in moderately ill out-patients. In contrast, we report on a sample of difficult-to-treat, predominantly severely ill, co-morbid, psychotic or therapy-refractory bipolar depressive in-patients. In this open and prospective study, 13 patients were treated with bupropion as an add-on strategy mainly to other antidepressants and to various mood stabilizers. Our data support the idea that bupropion is a first-line antidepressant in the treatment of severe bipolar depression. Eight of 13 patients showed a >50% reduction of Montgomery-Asberg Depression Scale ratings within 4 weeks. Co-medication with drugs commonly used in treatment-resistant bipolar disorder including venlafaxine, clozapine, lithium, topiramate and sodium valproate was safe in our small sample. While adhering to the suggestion of Goren and Levin not to exceed a daily dose of 450 mg of bupropion when treating bipolar depressed patients, we did not observe any switch from depression to hypomania or mania.
安非他酮是一种选择性去甲肾上腺素和多巴胺再摄取抑制剂，已被建议用于治疗双相抑郁，这不仅是因为其疗效，还因为其诱发轻躁狂或躁狂发作的风险可能较低。大多数关于安非他酮治疗双相情感障碍患者的研究是在病情中等的门诊患者中进行的。相比之下，我们报告了一组难以治疗的患者样本，这些患者主要是病情严重、合并症多、患有精神病或对治疗耐药的双相抑郁住院患者。在这项开放性前瞻性研究中，13名患者接受了安非他酮治疗，主要作为其他抗抑郁药和各种心境稳定剂的附加治疗策略。我们的数据支持安非他酮是治疗重度双相抑郁的一线抗抑郁药这一观点。13名患者中有8名在4周内蒙哥马利-阿斯伯格抑郁量表评分降低了50%以上。在我们的小样本中，与常用于难治性双相情感障碍治疗的药物（包括文拉法辛、氯氮平、锂盐、托吡酯和丙戊酸钠）联合用药是安全的。在遵循戈伦和莱文的建议，即治疗双相抑郁患者时安非他酮每日剂量不超过450毫克的情况下，我们未观察到任何从抑郁转为轻躁狂或躁狂的情况。
