Altshuler Lori, Suppes Trisha, Black David, Nolen Willem A, Keck Paul E, Frye Mark A, McElroy Susan, Kupka Ralph, Grunze Heinz, Walden Jörg, Leverich Gabrielle, Denicoff Kirk, Luckenbaugh David, Post Robert
Stanley Bipolar Treatment Network, USA.
Am J Psychiatry. 2003 Jul;160(7):1252-62. doi: 10.1176/appi.ajp.160.7.1252.
While guidelines for treating patients with bipolar depression recommend discontinuing antidepressants within 6 months after remission, few studies have assessed the implications of this strategy on the risk for depressive relapse. This study examined the effect of antidepressant discontinuation or continuation on depressive relapse risk among bipolar subjects successfully treated for an acute depressive episode.
Eighty-four subjects with bipolar disorder who achieved remission from a depressive episode with the addition of an antidepressant to an ongoing mood stabilizer regimen were followed prospectively for 1 year. The risk of depressive relapse among 43 subjects who stopped antidepressant treatment within 6 months after remission ("discontinuation group") was compared with the risk among 41 subjects who continued taking antidepressants beyond 6 months ("continuation group").
A Cox proportional hazards regression analysis indicated that shorter antidepressant exposure time following successful treatment was associated with a significantly shorter time to depressive relapse. Furthermore, patients who discontinued antidepressant treatment within the first 6 months after remission experienced a significantly shorter period of euthymia before depressive relapse over the length of 1-year follow-up. One year after successful antidepressant response, 70% of the antidepressant discontinuation group experienced a depressive relapse compared with 36% of the continuation group. By the 1-year follow-up evaluation, 15 (18%) of the 84 subjects had experienced a manic relapse; only six of these subjects were taking an antidepressant at the time of manic relapse.
The risk of depressive relapse in patients with bipolar illness was significantly associated with discontinuing antidepressants soon after remission. The risk of manic relapse was not significantly associated with continuing use of antidepressant medication and, overall, was substantially less than the risk of depressive relapse. Maintenance of antidepressant treatment in combination with a mood stabilizer may be warranted in some patients with bipolar disorder.
虽然双相抑郁患者的治疗指南建议在症状缓解后6个月内停用抗抑郁药，但很少有研究评估该策略对抑郁复发风险的影响。本研究探讨了停用或继续使用抗抑郁药对成功治疗急性抑郁发作的双相情感障碍患者抑郁复发风险的影响。
84例双相情感障碍患者在持续使用心境稳定剂的基础上加用抗抑郁药后抑郁发作缓解，对其进行了为期1年的前瞻性随访。将43例在症状缓解后6个月内停用抗抑郁药的患者（“停药组”）的抑郁复发风险与41例在6个月后继续服用抗抑郁药的患者（“继续用药组”）的风险进行比较。
Cox比例风险回归分析表明，成功治疗后抗抑郁药暴露时间较短与抑郁复发时间显著缩短相关。此外，在缓解后的前6个月内停用抗抑郁药的患者，在1年随访期内抑郁复发前的心境正常期明显较短。抗抑郁药治疗成功1年后，停药组70%的患者出现抑郁复发，而继续用药组为36%。到1年随访评估时，84例患者中有15例（18%）出现躁狂复发；这些患者中只有6例在躁狂复发时正在服用抗抑郁药。
双相情感障碍患者抑郁复发风险与缓解后不久停用抗抑郁药显著相关。躁狂复发风险与继续使用抗抑郁药无显著相关性，总体而言，躁狂复发风险远低于抑郁复发风险。对于一些双相情感障碍患者，可能有必要联用抗抑郁药和心境稳定剂进行维持治疗。
