Mondimore Francis M, Fuller Gregory A, DePaulo J Raymond
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA.
J Clin Psychiatry. 2003;64 Suppl 5:25-31.
With the release of new medications into the armamentarium for the treatment of bipolar disorder, clinicians are required to make prudent treatment decisions in light of insufficient research data for patients with a difficult-to-control illness. Increasingly, clinicians are turning toward a combination or adjunctive treatment out of necessity. Many studies suggest effectiveness of add-on agents in patients with mania who are unresponsive to one or more drugs, while only a limited number of controlled trials actually compare one particular combination regimen to another. Despite this lack of data, there has been no lack of advice for the clinician from clinical recommendations in the form of expert treatment guidelines to case reports describing suggestive findings from the off-label use of newer agents. With a particular emphasis on the treatment of mania, this article reviews the clinical data on the individual agents of foreseeable use in combination treatment for bipolar disorder. We suggest beginning with an agent of established effectiveness when combining medications for the treatment of bipolar disorder.
随着用于治疗双相情感障碍的新药物进入药物库，鉴于针对这种难以控制的疾病的患者缺乏足够的研究数据，临床医生需要做出谨慎的治疗决策。越来越多的临床医生出于必要转向联合治疗或辅助治疗。许多研究表明，对于对一种或多种药物无反应的躁狂症患者，添加药物是有效的，而实际上只有有限数量的对照试验将一种特定的联合治疗方案与另一种进行比较。尽管缺乏数据，但从以专家治疗指南形式出现的临床建议到描述新药物超说明书使用的提示性发现的病例报告，并不缺乏给临床医生的建议。本文特别强调躁狂症的治疗，回顾了双相情感障碍联合治疗中可预见使用的各个药物的临床数据。我们建议在联合使用药物治疗双相情感障碍时，从一种已证实有效的药物开始。
