CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Drugs. 2009 Oct 22;69(15):2063-101. doi: 10.2165/11318850-000000000-00000.
Bipolar disorder is a common, debilitating, chronic illness that emerges early in life and has serious consequences such as long-term unemployment and suicide. It confers considerable functional disability to the individual, their family and society as a whole and yet it is often undetected, misdiagnosed and treated poorly. In the past decade, many new treatment strategies have been trialled in the management of bipolar disorder with variable success. The emerging evidence, for pharmacological agents in particular, is promising but when considered alone does not directly translate to real-world clinical populations of bipolar disorder. Data from drug trials are largely based on findings that identify differences between groups determined in a time-limited manner, whereas clinical management concerns the treatment of individuals over the life-long course of the illness. Considering the findings in the context of the individual and their particular needs perhaps best bridges the gap between the evidence from research studies and their application in clinical practice. Specifically, only lithium and valproate have moderate or strong evidence for use across all three phases of bipolar disorder. Anticonvulsants, such as lamotrigine, have strong evidence in maintenance; whereas antipsychotics largely have strong evidence in acute mania, with the exception of quetiapine, which has strong evidence in bipolar depression. Maintenance data for antipsychotics is emerging but at present remains weak. Combinations have strong evidence in acute phases of illness but maintenance data is urgently needed. Conventional antidepressants only have weak evidence in bipolar depression and do not have a role in maintenance therapy. Therefore, this paper summarizes the efficacy data for treating bipolar disorder and also applies clinical considerations to these data when formulating recommendations for the management of bipolar disorder.
双相情感障碍是一种常见的、使人衰弱的、慢性疾病，它在生命早期出现，并且会导致严重的后果，例如长期失业和自杀。它会给个人、他们的家庭和整个社会带来相当大的功能障碍，但它常常未被发现、误诊和治疗不当。在过去的十年中，许多新的治疗策略已被尝试用于双相情感障碍的治疗，取得了不同程度的成功。新出现的证据，特别是药物治疗方面的证据，很有希望，但单独考虑时并不能直接转化为双相情感障碍的真实临床人群。药物试验的数据主要基于通过限时分组确定差异的发现，而临床管理则关注个体在疾病的整个病程中的治疗。从个体及其特定需求的角度考虑这些发现，也许可以最好地弥合研究证据与其在临床实践中的应用之间的差距。具体来说，只有锂盐和丙戊酸盐在双相情感障碍的所有三个阶段都有中度或强烈的证据支持使用。抗惊厥药，如拉莫三嗪，在维持治疗中有强有力的证据；而抗精神病药在急性躁狂症中有强有力的证据，除了喹硫平，它在双相抑郁症中有强有力的证据。抗精神病药的维持治疗数据正在出现，但目前仍然很薄弱。联合用药在疾病的急性期有强有力的证据，但急需维持治疗的数据。传统抗抑郁药在双相抑郁症中仅有微弱的证据，并且在维持治疗中没有作用。因此，本文总结了治疗双相情感障碍的疗效数据，并在制定双相情感障碍管理建议时将临床考虑因素应用于这些数据。
