Baker Robert W, Tohen Mauricio, Fawcett Jan, Risser Richard C, Schuh Leslie M, Brown Eileen, Stauffer Virginia L, Shao Lixin, Tollefson Gary D
Lilly Research Laboratories, Indianapolis, Indiana 46285, USA.
J Clin Psychopharmacol. 2003 Apr;23(2):132-7. doi: 10.1097/00004714-200304000-00005.
A substantial number of patients with mania have significant concomitant depressive features, and they may respond differently to mood stabilizers than patients with pure mania. This post-hoc analysis explored the response characteristics of olanzapine versus placebo in bipolar I manic patients with dysphoric and nondysphoric mania (differentiated by baseline Hamilton Depression Rating Scale [HAM-D] score of >20). Two similar, double-blind, randomized trials comparing olanzapine, 5-20 mg, to placebo were pooled for these analyses (N = 246). Mean changes in Young-Mania Rating Scale (Y-MRS) and HAM-D scores during 3 weeks of treatment were examined. Twenty-eight percent of patients had dysphoric mania (olanzapine, n = 33; placebo, n = 35). Among these patients, olanzapine-treated patients had greater improvement within 1 week than did placebo-treated patients on both mania ratings (Y-MRS: -9.7 vs. -3.0 points; = 0.011) and depressive symptom ratings (HAM-D: -9.9 vs. -5.4 points; = 0.025). Among those manic subjects without prominent depressive symptoms (olanzapine, n = 91; placebo, n = 87), mean Y-MRS improvement from baseline to endpoint with olanzapine (-11.5 points) versus placebo (-6.13 points) was comparable to the improvement seen with olanzapine versus placebo in the dysphoric mania subgroup ( = 0.476, test of interaction). In acutely ill manic patients with significant depressive symptoms, olanzapine demonstrated a broad spectrum of efficacy, effectively treating both manic and depressive symptoms. The magnitude of the antimanic response appears similar, regardless of baseline depressive features. Additional experience with putative mood stabilizers and atypical agents in mixed mania should include an exploration of their efficacy in treating both manic and depressive mood symptoms.
大量躁狂患者伴有显著的抑郁特征，与单纯躁狂患者相比，他们对心境稳定剂的反应可能不同。这项事后分析探讨了奥氮平与安慰剂在伴有烦躁性和非烦躁性躁狂的双相I型躁狂患者（根据基线汉密尔顿抑郁量表[HAM-D]评分>20区分）中的反应特征。将两项比较5 - 20 mg奥氮平与安慰剂的相似、双盲、随机试验合并进行这些分析（N = 246）。检查了治疗3周期间Young躁狂评定量表（Y-MRS）和HAM-D评分的平均变化。28%的患者患有烦躁性躁狂（奥氮平组，n = 33；安慰剂组，n = 35）。在这些患者中，奥氮平治疗的患者在1周内的躁狂评分（Y-MRS：-9.7 vs. -3.0分；P = 0.011）和抑郁症状评分（HAM-D：-9.9 vs. -5.4分；P = 0.025）方面比安慰剂治疗的患者有更大改善。在那些没有明显抑郁症状的躁狂受试者中（奥氮平组，n = 91；安慰剂组，n = 87），从基线到终点奥氮平组的Y-MRS平均改善（-11.5分）与安慰剂组（-6.13分）相当，与烦躁性躁狂亚组中奥氮平与安慰剂的改善情况相当（P = 0.476，交互作用检验）。在伴有显著抑郁症状的急性躁狂患者中，奥氮平显示出广泛的疗效，能有效治疗躁狂和抑郁症状。无论基线抑郁特征如何，抗躁狂反应的程度似乎相似。在混合性躁狂中使用假定的心境稳定剂和非典型药物的更多经验应包括探索它们在治疗躁狂和抑郁情绪症状方面的疗效。
