Yatham Lakshmi N, Kusumakar Vivek, Calabrese Joseph R, Rao Rajeev, Scarrow Gayle, Kroeker Garth
Department of Psychiatry, University of British Columbia, Vancouver, Canada.
J Clin Psychiatry. 2002 Apr;63(4):275-83. doi: 10.4088/jcp.v63n0402.
To review the literature on efficacy of third generation anticonvulsants for treatment of bipolar disorder and provide clinical recommendations.
Open and controlled studies, case reports, and case series on the efficacy of lamotrigine, gabapentin, topiramate, tiagabine, and zonisamide were located through electronic searches of several databases, by manual search of proceedings of international meetings, and through contacting authors of recent reports.
Lamotrigine is the best studied anticonvulsant and has efficacy in acute bipolar depression and in longer term treatment of bipolar depression as well as rapid-cycling bipolar II disorder but not in acute mania. Open reports suggest usefulness of gabapentin as an adjunct in bipolar disorder, but double-blind trials failed to confirm efficacy in acute mania and treatment-resistant rapid-cycling bipolar disorder. Topiramate is reported to be effective in acute mania and rapid-cycling bipolar disorder in several open studies, but methodological problems in a double-blind study led to a failed study in acute mania. However, topiramate may lead to weight loss in some patients. Zonisamide deserves further investigation, but tiagabine does not appear to be useful in acute mania.
Lamotrigine clearly fills an unmet need in treating bipolar depression and rapid-cycling bipolar disorder. Other third generation anticonvulsants with the exception of tiagabine offer promise but require confirmation of their efficacy from double-blind studies.
回顾关于第三代抗惊厥药治疗双相情感障碍疗效的文献并提供临床建议。
通过对多个数据库进行电子检索、人工检索国际会议论文集以及联系近期报告的作者，查找有关拉莫三嗪、加巴喷丁、托吡酯、噻加宾和唑尼沙胺疗效的开放和对照研究、病例报告及病例系列。
拉莫三嗪是研究最多的抗惊厥药，对急性双相抑郁、双相抑郁的长期治疗以及快速循环型双相II障碍有效，但对急性躁狂无效。开放报告提示加巴喷丁作为双相情感障碍的辅助用药可能有用，但双盲试验未能证实其对急性躁狂和难治性快速循环型双相情感障碍有效。在多项开放研究中，托吡酯据报道对急性躁狂和快速循环型双相情感障碍有效，但一项双盲研究中的方法学问题导致急性躁狂研究失败。然而，托吡酯可能导致部分患者体重减轻。唑尼沙胺值得进一步研究，但噻加宾似乎对急性躁狂无效。
拉莫三嗪在治疗双相抑郁和快速循环型双相情感障碍方面明确满足了一项未被满足的需求。除噻加宾外，其他第三代抗惊厥药有前景，但需要双盲研究证实其疗效。
