Calabrese Joseph R, Elhaj Omar, Gajwani Prashant, Gao Keming
University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
J Clin Psychiatry. 2005;66 Suppl 5:26-33.
Despite the considerable burden of bipolar depression, the treatment of this debilitating phase of bipolar disorder is suboptimally addressed by currently available pharmacologic options. Consequently, there is a need for the development of new treatment options with enhanced efficacy and tolerability. Evidence of antidepressant efficacy for some of the atypical antipsychotics in the treatment of bipolar depression has recently emerged. The findings of a large-scale, placebo-controlled, double-blind, randomized clinical study of olanzapine alone and in combination with fluoxetine, and a similar study of quetiapine monotherapy, suggest that some of the atypical antipsychotics may be efficacious in treating depressive symptoms in patients with bipolar I disorder. Subpopulation analyses suggest that quetiapine monotherapy and the olanzapine plus fluoxetine combination appear to be effective in treating depression in patients with a rapid-cycling course. The magnitude of improvement in depressive symptoms in the bipolar I population appears to be larger for quetiapine monotherapy compared with either olanzapine or olanzapine plus fluoxetine; however, the limitations of such a cross-study comparison are acknowledged. Both olanzapine monotherapy and combination therapy, as well as quetiapine monotherapy, were well tolerated. The overall incidence of treatment-emergent mania was low and comparable with placebo in both studies. Somnolence, weight gain, increased appetite and nonfasting glucose and cholesterol levels were more commonly reported in patients treated with olanzapine monotherapy or combination therapy compared with placebo. Dry mouth, sedation/somnolence, dizziness, and constipation were more commonly associated with quetiapine treatment. Large, controlled studies are needed to determine whether other psychotropic agents have antidepressant properties that would make them suitable for use in patients with bipolar depression. In addition, direct comparison of the regimens used in the current study should determine whether the differences evident between them can be confirmed.
尽管双相抑郁负担沉重，但双相情感障碍这一衰弱阶段的治疗，目前可用的药物选择并未得到优化解决。因此，需要开发疗效更高且耐受性更好的新治疗方案。近期出现了一些非典型抗精神病药物治疗双相抑郁具有抗抑郁疗效的证据。一项关于奥氮平单药治疗及与氟西汀联合治疗的大规模、安慰剂对照、双盲、随机临床研究，以及一项关于喹硫平单药治疗的类似研究结果表明，某些非典型抗精神病药物可能对治疗双相I型障碍患者的抑郁症状有效。亚组分析表明，喹硫平单药治疗以及奥氮平加氟西汀联合治疗似乎对快速循环病程患者的抑郁治疗有效。与奥氮平或奥氮平加氟西汀相比，喹硫平单药治疗在双相I型患者中抑郁症状改善程度似乎更大；然而，承认这种跨研究比较存在局限性。奥氮平单药治疗和联合治疗以及喹硫平单药治疗耐受性均良好。两项研究中治疗中出现躁狂的总体发生率均较低且与安慰剂相当。与安慰剂相比，接受奥氮平单药治疗或联合治疗的患者更常报告嗜睡、体重增加、食欲增加以及非空腹血糖和胆固醇水平升高。口干、镇静/嗜睡、头晕和便秘与喹硫平治疗更常相关。需要进行大规模对照研究，以确定其他精神药物是否具有抗抑郁特性，使其适合用于双相抑郁患者。此外，对本研究中使用的治疗方案进行直接比较，应能确定它们之间明显的差异是否可以得到证实。
