Post R M, Altshuler L L, Leverich G S, Frye M A, Nolen W A, Kupka R W, Suppes T, McElroy S, Keck P E, Denicoff K D, Grunze H, Walden J, Kitchen C M R, Mintz J
Department of Health and Human Services, National Institute of Mental Health, Bethesda, Maryland, USA.
Br J Psychiatry. 2006 Aug;189:124-31. doi: 10.1192/bjp.bp.105.013045.
Few studies have examined the relative risks of switching into hypomania or mania associated with second-generation antidepressant drugs in bipolar depression.
To examine the relative acute effects of bupropion, sertraline and venlafaxine as adjuncts to mood stabilisers.
In a 10-week trial, participants receiving out-patient treatment for bipolar disorder (stratified for rapid cycling) were randomly treated with a flexible dose of one of the antidepressants, or their respective matching placebos, as adjuncts to mood stabilisers.
A total of 174 adults with bipolar disorder I, II or not otherwise specified, currently in the depressed phase, were included. All three antidepressants were associated with a similar range of acute response (49-53%) and remission (34-41%). There was a significantly increased risk of switches into hypomania or mania in participants treated with venlafaxine compared with bupropion or sertraline.
More caution appears indicated in the use of venlafaxine rather than bupropion or sertraline in the adjunctive treatment of bipolar depression, especially if there is a prior history of rapid cycling.
很少有研究探讨双相抑郁患者使用第二代抗抑郁药物后转为轻躁狂或躁狂的相对风险。
研究安非他酮、舍曲林和文拉法辛作为心境稳定剂辅助用药的相对急性效应。
在一项为期10周的试验中，接受双相情感障碍门诊治疗（根据快速循环分层）的参与者被随机给予灵活剂量的一种抗抑郁药物或其相应的匹配安慰剂，作为心境稳定剂的辅助用药。
总共纳入了174名处于抑郁期的双相I型、II型或未另行明确诊断的双相情感障碍成年患者。所有三种抗抑郁药物的急性反应（49 - 53%）和缓解率（34 - 41%）范围相似。与安非他酮或舍曲林相比，接受文拉法辛治疗的参与者转为轻躁狂或躁狂的风险显著增加。
在双相抑郁的辅助治疗中，使用文拉法辛似乎比安非他酮或舍曲林更需谨慎，尤其是有快速循环病史的患者。
