Bergsholm P, Martinsen E W, Svoen N, Olsen T, Holsten F, Neckelmann D, Aarre T F
Psykiatrisk klinikk, Sentralsjukehuset i Sogn og Fjordane, Førde.
Tidsskr Nor Laegeforen. 1992 Aug 30;112(20):2651-6.
Optimal treatment of mood disorders and prevention of suicide requires biological and psychosocial methods, therapeutic alliance and psycho-education. In moderate unipolar depression an antidepressant may be sufficient, if necessary potentiated by another antidepressant or triiodothyronine. In moderate bipolar depression lithium or carbamazepine are preferred. In severe unipolar and bipolar depression the combination of an antidepressant and lithium (or carbamazepine) or electroconvulsive therapy (ECT) is indicated, in psychotic depression neuroleptics, too. Non-selective monoamine oxidase inhibitors (MAOIs) are the most potent antidepressants. Moderate acute mania and mixed state may respond to lithium, carbamazepine or valproate only. In severe cases a neuroleptic and lithium are combined, or these drugs may be combined with carbamazepine or valproate. Electroconvulsive therapy is preferable in acute mixed states with marked confusion or depression. In chronic mixed state and rapid cycling, withdrawal of antidepressants and neuroleptics should be tried. Most patients will need a combination of lithium and carbamazepine or valproate. Added to these drugs, antidepressants are less risky. Adding thyroxin may stabilize rapid cycling. The combination of lithium and an antidepressant is the most potent prophylaxis in unipolar disorder and bipolar disorder dominated by depression.
心境障碍的最佳治疗及自杀预防需要生物学和社会心理方法、治疗联盟及心理教育。对于中度单相抑郁，若有必要，一种抗抑郁药联合另一种抗抑郁药或三碘甲状腺原氨酸增强疗效可能就足够了。对于中度双相抑郁，首选锂盐或卡马西平。对于重度单相和双相抑郁，推荐使用抗抑郁药与锂盐（或卡马西平）联合或采用电休克治疗（ECT），对于伴有精神病性症状的抑郁，也可使用抗精神病药物。非选择性单胺氧化酶抑制剂（MAOIs）是最有效的抗抑郁药。中度急性躁狂和混合状态可能仅对锂盐、卡马西平或丙戊酸盐有反应。在严重病例中，可联合使用抗精神病药物和锂盐，或者这些药物可与卡马西平或丙戊酸盐联合使用。在伴有明显意识模糊或抑郁的急性混合状态下，电休克治疗更为可取。对于慢性混合状态和快速循环发作，应尝试停用抗抑郁药和抗精神病药物。大多数患者需要锂盐与卡马西平或丙戊酸盐联合使用。在这些药物基础上加用抗抑郁药风险较小。加用甲状腺素可能使快速循环发作得到稳定。锂盐与抗抑郁药联合是单相障碍及以抑郁为主的双相障碍最有效的预防方法。
