Lydon Eric, El-Mallakh Rif S
Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY 40202, USA.
J Clin Psychopharmacol. 2006 Oct;26(5):516-8. doi: 10.1097/01.jcp.0000236655.62920.dc.
Antidepressant use seems to be problematic in bipolar disorder. The dopaminergic agent, bupropion, seems to be equally effective to serotoninergic agents but with greater safety. Methylphenidate is a stimulant medication that is sometimes used as an antidepressant in bipolar adults and is frequently used in children with comorbid bipolar and attention-deficit disorder. There are no data available for the safety of long-term methylphenidate in adults. A retrospective chart review of bipolar patients who received methylphenidate while attending a bipolar clinic was conducted. Data regarding side effects and symptoms were collected. Sixteen charts were reviewed. The mean duration of methylphenidate treatment was 14 months (+/-SD, +/-17.5 months; range, 1-60 months). Five had comorbid attention-deficit disorder, the remainder received the methylphenidate for depression. The mean dose was 16.3 mg/d (+/-SD, +/-8.7 mg/d; range, 5-40 mg/d). Several mild to moderate side effects were reported. Two patients (12.5%) discontinued methylphenidate because of adverse side effects. When available (44% of the sample), general assessment of function increased from (+/-SD) 48.3 +/- 9.9 to 69.3 +/- 10.6 (P = 0.006). Methylphenidate seems to be safe in the naturalistic setting. Controlled studies are needed to confirm its efficacy and safety in bipolar depression.
在双相情感障碍中，使用抗抑郁药似乎存在问题。多巴胺能药物安非他酮似乎与5-羟色胺能药物效果相当，但安全性更高。哌醋甲酯是一种兴奋剂药物，有时用于双相情感障碍成年患者的抗抑郁治疗，也常用于患有双相情感障碍合并注意力缺陷障碍的儿童。目前尚无关于哌醋甲酯在成人中长期使用安全性的数据。对在双相情感障碍门诊接受哌醋甲酯治疗的双相情感障碍患者进行了一项回顾性病历审查。收集了有关副作用和症状的数据。共审查了16份病历。哌醋甲酯治疗的平均持续时间为14个月（±标准差，±17.5个月；范围为1 - 60个月）。其中5例患有合并注意力缺陷障碍，其余患者接受哌醋甲酯治疗是为了缓解抑郁症状。平均剂量为16.3毫克/天（±标准差，±8.7毫克/天；范围为5 - 40毫克/天）。报告了几种轻度至中度的副作用。两名患者（12.5%）因不良反应而停用哌醋甲酯。在可获取数据的情况下（样本的44%），功能总体评估从（±标准差）48.3±9.9提高到了69.3±10.6（P = 0.006）。在自然环境中，哌醋甲酯似乎是安全的。需要进行对照研究以证实其在双相情感障碍抑郁治疗中的疗效和安全性。
