Bowden Charles L
Department of Psychiatry, University of Texas Health Science Center at San Antonio, TX 78229, USA.
J Clin Psychiatry. 2004;65 Suppl 15:21-4.
Because patients with bipolar disorder often do not respond sufficiently to treatment with 1 mood stabilizer, psychiatrists frequently employ combination therapy and add antipsychotics, antiepileptics, or antidepressants to mood stabilizers. Combination therapy can be more effective than monotherapy in controlling breakthrough or treatment-resistant episodes. For example, atypical antipsychotics have been shown to be effective adjunctive treatments for mania and for patients with psychotic symptoms during a depressive episode, while the combination of a mood stabilizer and lamotrigine or an anti-depressant has been found to control bipolar depression. The American Psychiatric Association guideline for the treatment of bipolar disorder recommends optimizing individual medications before switching to combination therapy. Selecting a combination treatment regimen with an acceptable side effect profile is critically important because patients may discontinue therapy they cannot tolerate. Agents should be added carefully, with continued monitoring of adverse effects. Physicians should give patients only as much medication as needed.
由于双相情感障碍患者通常对单一情绪稳定剂治疗反应不足，精神科医生经常采用联合治疗，在情绪稳定剂的基础上加用抗精神病药、抗癫痫药或抗抑郁药。联合治疗在控制突破性发作或难治性发作方面可能比单一疗法更有效。例如，非典型抗精神病药已被证明是治疗躁狂发作以及抑郁发作时有精神病性症状患者的有效辅助治疗药物，而情绪稳定剂与拉莫三嗪或抗抑郁药联合使用已被发现可控制双相抑郁。美国精神病学协会双相情感障碍治疗指南建议在转向联合治疗之前优化单一药物治疗。选择具有可接受副作用的联合治疗方案至关重要，因为患者可能会停用他们无法耐受的治疗。药物应谨慎添加，并持续监测不良反应。医生应仅给予患者所需剂量的药物。
