Yerevanian Boghos I, Koek Ralph J, Mintz Jim, Akiskal Hagop S
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles 16111 Plummer Street, North Hills, CA 91343, United States.
J Affect Disord. 2007 Nov;103(1-3):13-21. doi: 10.1016/j.jad.2007.05.017. Epub 2007 Jul 6.
Antidepressant-induced mania and cycle acceleration is a potential risk in bipolar patients. Another serious risk of antidepressants, that of increasing suicidal behavior, has been identified in some affectively ill populations. However, there is a dearth of knowledge about the effects of antidepressants on suicidal behavior specifically in bipolar patients.
Retrospective chart review of 405 veterans with bipolar disorder followed for a mean of three years, with month by month systematic assessment of current pharmacotherapy and suicide completion, attempt or hospitalization for suicidality. Chi-squared comparison of (log) rates of suicidal events during mood stabilizer monotherapy, antidepressant monotherapy, and combination of mood stabilizer and antidepressant.
Suicidal behavior event rates (per 100 patient years) were greatest during treatment with antidepressant monotherapy (25.92), least during mood stabilizer monotherapy (3.48), and intermediate during mood stabilizer + antidepressant combination treatment (9.75). These differences were statistically significant.
In a clinical setting, antidepressants may have been prescribed because patients were deemed at greater risk of suicidality.
During treatment with antidepressants (even when coupled with mood stabilizers), patients with bipolar disorder have significantly higher rates of non-lethal suicidal behavior compared to those on mood stabilizers without antidepressants, and thus require careful monitoring.
抗抑郁药诱发的躁狂和周期加速是双相情感障碍患者的潜在风险。抗抑郁药的另一个严重风险，即增加自杀行为，已在一些情感障碍患者群体中得到确认。然而，关于抗抑郁药对自杀行为的影响，特别是在双相情感障碍患者中的影响，目前知之甚少。
对405名双相情感障碍退伍军人进行回顾性病历审查，平均随访三年，逐月系统评估当前药物治疗情况以及自杀死亡、自杀未遂或因自杀倾向住院情况。对心境稳定剂单药治疗、抗抑郁药单药治疗以及心境稳定剂与抗抑郁药联合治疗期间自杀事件（对数）发生率进行卡方比较。
抗抑郁药单药治疗期间自杀行为事件发生率（每100患者年）最高（25.92），心境稳定剂单药治疗期间最低（3.48），心境稳定剂加抗抑郁药联合治疗期间居中（9.75）。这些差异具有统计学意义。
在临床环境中，可能是因为认为患者自杀风险更高才开具抗抑郁药。
与仅使用心境稳定剂而未使用抗抑郁药的患者相比，双相情感障碍患者在使用抗抑郁药治疗期间（即使与心境稳定剂联合使用），非致命性自杀行为的发生率显著更高，因此需要密切监测。
