Yildiz Aysegul, Sachs Gary S
Dokuz Eylul Medical School, Department of Psychiatry, Izmir, Turkey.
J Clin Psychiatry. 2003 Jul;64(7):814-8. doi: 10.4088/jcp.v64n0712.
To investigate the influence of antidepressant use and gender in the genesis of rapid-cycling bipolar illness.
The charts of bipolar patients treated at the Massachusetts General Hospital Bipolar Clinic (Boston, Mass.) were reviewed for gender, presence or absence of rapid cycling, and antidepressant use prior to first mania.
Data were obtained for 129 bipolar patients (55% women), 45% of whom had experienced a rapid-cycling course. Overall, there was no significant difference in the rates of rapid cycling between the subjects who were exposed to antidepressants prior to their first manic/ hypomanic episode and those who were not. Additional analysis carried out separately by gender found a significant association between rapid cycling and antidepressant use prior to first mania/hypomania for women but not for men. A logistic regression analysis with rapid cycling as dependent variable revealed a significant interaction between antidepressant use prior to first mania/hypomania and gender.
We found a gender-specific relationship between antidepressant use prior to first manic/hypomanic episode and rapid-cycling bipolar illness. When antidepressants are prescribed to depressed women who have a risk of bipolar disorder, the risk of inducing rapid cycling should be considered. Differing proportions of women and men in previous studies may account for conflicting results reported in the literature for the relationship of antidepressants and rapid cycling. However, this naturalistic trial was uncontrolled, and controlled research is required to confirm our findings.
探讨使用抗抑郁药及性别对快速循环型双相情感障碍发病的影响。
回顾马萨诸塞州综合医院双相情感障碍门诊（马萨诸塞州波士顿）治疗的双相情感障碍患者的病历，记录患者性别、是否有快速循环发作以及首次躁狂发作前抗抑郁药的使用情况。
获取了129例双相情感障碍患者的数据（55%为女性），其中45%经历过快速循环病程。总体而言，首次躁狂/轻躁狂发作前使用过抗抑郁药的患者与未使用过抗抑郁药的患者相比，快速循环发作的发生率无显著差异。按性别分别进行的进一步分析发现，女性首次躁狂/轻躁狂发作前快速循环发作与使用抗抑郁药之间存在显著关联，而男性则无此关联。以快速循环发作为因变量的逻辑回归分析显示，首次躁狂/轻躁狂发作前使用抗抑郁药与性别之间存在显著交互作用。
我们发现首次躁狂/轻躁狂发作前使用抗抑郁药与快速循环型双相情感障碍之间存在性别特异性关系。给有双相情感障碍风险的抑郁女性开抗抑郁药时，应考虑诱发快速循环发作的风险。以往研究中男女比例不同可能是文献中报道的抗抑郁药与快速循环发作关系结果相互矛盾的原因。然而，这项自然观察性试验未设对照，需要进行对照研究来证实我们的发现。
