Azorin Jean-Michel, Kaladjian Arthur
Pôle Universitaire de Psychiatrie-Solaris, Hôpital Ste Marguerite, 13274 Marseille Cedex 9, France.
Expert Opin Pharmacother. 2009 Feb;10(2):161-72. doi: 10.1517/14656560802653172.
Although depression accounts for a large part of the burden associated with bipolar disorder, its drug treatment has been under-studied.
To provide the best available evidence supporting the pharmacotherapy of bipolar depression.
A systematic review was conducted, focusing on randomized, controlled trials (RCTs) and meta-analyses.
RESULTS/CONCLUSIONS: Despite FDA approval of both the olanzapine-fluoxetine combination and quetiapine for the treatment of acute bipolar depression, independent RCTs (i.e., not trials conducted 'under the umbrella' of a drug company) have not found any drug to have antidepressant effects similar to those seen in unipolar depression. A practice-based suggestion, valuable for both short- and long-term treatment, might be to have a background of mood stabilizers and to add drugs, following one of several treatment options, trusting to find a drug with a degree of effectiveness by trial and error. The list of drugs that could be used would include all the current antidepressants, the olanzapine-fluoxetine combination and probably quetiapine too. Special features and situations might also influence treatment options.
尽管抑郁症在双相情感障碍相关负担中占很大一部分，但其药物治疗研究不足。
提供支持双相抑郁药物治疗的最佳现有证据。
进行了一项系统评价，重点关注随机对照试验（RCT）和荟萃分析。
结果/结论：尽管美国食品药品监督管理局（FDA）已批准奥氮平-氟西汀组合和喹硫平用于治疗急性双相抑郁，但独立的随机对照试验（即非在制药公司“保护伞”下进行的试验）并未发现任何药物具有与单相抑郁中所见相似的抗抑郁作用。一个对短期和长期治疗都有价值的基于实践的建议可能是，以心境稳定剂为基础，并根据几种治疗选择之一添加药物，相信通过反复试验找到一种具有一定疗效的药物。可使用的药物清单将包括所有现有的抗抑郁药、奥氮平-氟西汀组合，可能还有喹硫平。特殊特征和情况也可能影响治疗选择。
