Vigo Daniel V, Baldessarini Ross J
Department of Psychiatry, Harvard Medical School, MA, USA.
Harv Rev Psychiatry. 2009;17(4):231-41. doi: 10.1080/10673220903129814.
Major depressive disorder (MDD) is highly prevalent, potentially disabling, and sometimes fatal. Antidepressants (ADs) have improved its treatment, but incomplete response, sustained morbidity, recurrences, agitation, substance abuse, excess medical mortality, and suicide remain unsolved problems among mood disorder patients. AD treatment itself sometimes induces adverse behavioral responses. Several anticonvulsants (ACs) used to treat bipolar disorder (BPD) might also be of value for MDD. Accordingly, we reviewed published reports on ACs for MDD, identifying studies by computerized searches. We excluded reports dealing only with BPD patients or with sedatives, classified trials by design quality, and evaluated treatment of acute episodes and recurrences of adult MDD. We found 36 reports involving 41 relevant trials of carbamazepine (12 trials), valproate (11), lamotrigine (9), gabapentin (3), topiramate (3), phenytoin (2), and tiagabine (1). They include 9 blinded, controlled trials (of 28-70 days), involving carbamazepine (3 trials), lamotrigine (3), phenytoin (2), or topiramate (1) as primary treatments (5) or AD adjuncts (4). Some of these trials, as well as 7 of lesser quality, suggest benefits of carbamazepine, lamotrigine, and valproate, mainly as adjuncts to ADs. Another 20 anecdotes or small trials further suggest that these ACs might be useful as AD adjuncts-specifically to treat irritability or agitation in MDD. Overall, these reports provide suggestive evidence of beneficial effects of carbamazepine, lamotrigine, and valproate that require further study, especially for long-term adjunctive use, particularly in patients with recurring MDD with prominent irritability or agitation.
重度抑郁症（MDD）极为常见，可能导致残疾，有时甚至会致命。抗抑郁药（ADs）改善了其治疗效果，但疗效不完全、持续发病、复发、激动、药物滥用、医疗死亡率过高以及自杀等问题在情绪障碍患者中仍然悬而未决。AD治疗本身有时会引发不良行为反应。一些用于治疗双相情感障碍（BPD）的抗惊厥药（ACs）对MDD可能也有价值。因此，我们回顾了已发表的关于ACs治疗MDD的报告，通过计算机检索来确定相关研究。我们排除了仅涉及BPD患者或镇静剂的报告，根据设计质量对试验进行分类，并评估了成人MDD急性发作和复发的治疗情况。我们找到了36篇报告，涉及41项相关试验，其中卡马西平试验12项、丙戊酸盐试验11项、拉莫三嗪试验9项、加巴喷丁试验3项、托吡酯试验3项、苯妥英试验2项、噻加宾试验1项。这些试验包括9项双盲对照试验（为期28 - 70天），其中以卡马西平（3项试验）、拉莫三嗪（3项）、苯妥英（2项）或托吡酯（1项）作为主要治疗药物（共5项试验）或AD辅助药物（共4项试验）。这些试验中的一些，以及7项质量稍差的试验，表明卡马西平、拉莫三嗪和丙戊酸盐有一定益处，主要作为AD的辅助药物。另外20篇轶事报道或小型试验进一步表明，这些ACs作为AD辅助药物可能有用，特别是用于治疗MDD中的易怒或激动症状。总体而言，这些报告提供了卡马西平、拉莫三嗪和丙戊酸盐有益效果的提示性证据，需要进一步研究，尤其是长期辅助使用方面，特别是对于复发且伴有明显易怒或激动症状的MDD患者。
