Assistant Professor of Psychiatry, Mashhad University of Medical Science Mashhad, Iran.
Neuropsychiatr Dis Treat. 2008 Feb;4(1):227-34. doi: 10.2147/ndt.s2316.
The treatment of dysphoric mania is challenging given the need to treat symptoms of both depression and mania simultaneously without provoking any clinical exacerbation. The newer antiepileptic drugs such as gabapentin, lamotrogine, and carbamazepine are often used as adjuncts to either lithium or valproic acid in the treatment of bipolar disorder. We decided to undertake a monotherapy trial because previous evidence suggested mixed states may be more responsive to anticonvulsants than more traditional antimanic agents. 51 patients with a DSM IV diagnosis of dysphoric mania were randomized to three groups comprising gapbapentin, lamotrogine or carbamazepine and followed for 8 weeks. Psychiatric diagnosis was verified by the structural clinical interview for the DSM-IV (SCID). The MMPI-2 in full was used to assess symptoms at baseline and 8 weeks. All three groups showed significant changes in MMPI-2 scores for depression and mania subscales. Gabapentin showed the greatest change in depression symptom improvement relative to lamotrogine and carbamazepine, respectively. Although manic symptoms improved overall, here were no differences between groups in the degree of manic symptom improvement.
由于需要同时治疗抑郁和躁狂的症状，而又不引起任何临床恶化，因此治疗恶劣心境躁狂是具有挑战性的。新型抗癫痫药物如加巴喷丁、拉莫三嗪和卡马西平通常作为锂或丙戊酸盐治疗双相情感障碍的辅助药物。我们决定进行单药治疗试验，因为之前的证据表明混合状态可能对抗惊厥药比更传统的抗躁狂药更敏感。51 名符合 DSM-IV 恶劣心境躁狂诊断的患者被随机分为加巴喷丁、拉莫三嗪或卡马西平三组，并随访 8 周。精神科诊断通过 DSM-IV 结构临床访谈（SCID）进行验证。在基线和 8 周时使用完整的 MMPI-2 评估症状。所有三组在 MMPI-2 抑郁和躁狂分量表的评分上均显示出显著变化。加巴喷丁相对于拉莫三嗪和卡马西平显示出最大的抑郁症状改善。尽管躁狂症状总体上有所改善，但各组之间在躁狂症状改善的程度上没有差异。
