Lieberman Daniel Z, Goodwin Frederick K
Department of Psychiatry and Behavioral Sciences, George Washington University, 2150 Pennsylvania Ave, NW, Washington, DC 20037, USA.
Curr Psychiatry Rep. 2004 Dec;6(6):459-65. doi: 10.1007/s11920-004-0011-2.
Expert consensus emphasizes the need for better recognition and accurate diagnosis of bipolar disorder. Current research on lithium, divalproex, and lamotrigine provides new insight into the effective management of this illness. Advances in identifying the mechanism of action of mood stabilization has focused on signaling pathways within the cell that are associated with neurotrophic effects. Clinical research has led to confirmatory evidence of the efficacy of lithium in all phases of bipolar disorder, with the greatest effects seen in the treatment and prevention of mania. Compared to divalproex, lithium also has been found to have greater efficacy in the prevention of suicide. Lamotrigine has emerged as a first line treatment for bipolar depression, which is an area of weakness for other mood stabilizers. Oral loading of divalproex leads to rapid stabilization of mania without imposing a greater adverse effect burden than conventional dosing. Because no agent is universally effective in all phases of the illness, combination therapy with two or more agents often is the best option.
专家共识强调需要更好地识别和准确诊断双相情感障碍。目前关于锂盐、丙戊酸和拉莫三嗪的研究为有效管理这种疾病提供了新的见解。在确定情绪稳定作用机制方面的进展集中在细胞内与神经营养作用相关的信号通路。临床研究已证实锂盐在双相情感障碍各阶段均有效，在治疗和预防躁狂方面效果最为显著。与丙戊酸相比，锂盐在预防自杀方面也被发现有更高的疗效。拉莫三嗪已成为双相抑郁的一线治疗药物，而双相抑郁是其他心境稳定剂的薄弱环节。丙戊酸口服负荷疗法可使躁狂迅速稳定，且不会比传统给药带来更大的不良反应负担。由于没有一种药物在疾病的所有阶段都普遍有效，联合使用两种或更多药物通常是最佳选择。
