Fountoulakis Konstantinos N, Vieta Eduard, Siamouli Melina, Valenti Marc, Magiria Stamatia, Oral Timucin, Fresno David, Giannakopoulos Panteleimon, Kaprinis George S
Third Department of Psychiatry, Aristotle University of Thessaloniki, Greece.
Ann Gen Psychiatry. 2007 Oct 9;6:27. doi: 10.1186/1744-859X-6-27.
Manic-depression or bipolar disorder (BD) is a multi-faceted illness with an inevitably complex treatment.
This article summarizes the current status of our knowledge and practice of its treatment.
It is widely accepted that lithium is moderately useful during all phases of bipolar illness and it might possess a specific effectiveness on suicidal prevention. Both first and second generation antipsychotics are widely used and the FDA has approved olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole for the treatment of acute mania. These could also be useful in the treatment of bipolar depression, but only limited data exists so far to support the use of quetiapine monotherapy or the olanzapine-fluoxetine combination. Some, but not all, anticonvulsants possess a broad spectrum of effectiveness, including mixed dysphoric and rapid-cycling forms. Lamotrigine may be effective in the treatment of depression but not mania. Antidepressant use is controversial. Guidelines suggest their cautious use in combination with an antimanic agent, because they are supposed to induce switching to mania or hypomania, mixed episodes and rapid cycling.
The first-line psychosocial intervention in BD is psychoeducation, followed by cognitive-behavioral therapy. Other treatment options include Electroconvulsive therapy and transcranial magnetic stimulation. There is a gap between the evidence base, which comes mostly from monotherapy trials, and clinical practice, where complex treatment regimens are the rule.
躁郁症或双相情感障碍（BD）是一种多方面的疾病，其治疗不可避免地很复杂。
本文总结了我们对其治疗的知识和实践现状。
人们普遍认为锂盐在双相情感障碍的各个阶段都有一定作用，并且可能对预防自杀有特定效果。第一代和第二代抗精神病药物都被广泛使用，美国食品药品监督管理局（FDA）已批准奥氮平、利培酮、喹硫平、齐拉西酮和阿立哌唑用于治疗急性躁狂。这些药物在治疗双相抑郁方面可能也有用，但目前仅有有限的数据支持喹硫平单药治疗或奥氮平 - 氟西汀联合治疗的使用。一些（但不是全部）抗惊厥药物具有广泛的疗效，包括混合性烦躁和快速循环型。拉莫三嗪可能对治疗抑郁有效，但对躁狂无效。抗抑郁药的使用存在争议。指南建议谨慎将其与抗躁狂药物联合使用，因为它们可能会诱发转躁狂或轻躁狂、混合发作和快速循环。
双相情感障碍的一线心理社会干预是心理教育，其次是认知行为疗法。其他治疗选择包括电休克疗法和经颅磁刺激。主要来自单药治疗试验的证据基础与临床实践（复杂治疗方案是常规）之间存在差距。
