3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6 Odysseos Str. (Parodos Ampelonon Str.), Pylaia, Thessaloniki, Greece.
Curr Opin Psychiatry. 2010 Jan;23(1):19-24. doi: 10.1097/YCO.0b013e328333e132.
The current article attempts to summarize the current status of our knowledge and practice in the treatment of bipolar depression and suggests future directions.
Our knowledge about lithium solidly supports its usefulness during all phases of bipolar illness and its specific effectiveness on suicidal prevention. Specific second-generation antipsychotics could constitute a promising option for treating bipolar depression, although only limited data exist so far. Anticonvulsants appear to possess a broad spectrum of effectiveness, including mixed dysphoric and rapid-cycling forms. Lamotrigine may be preferably effective in the treatment of depression but not mania. The usefulness of antidepressants in bipolar depression is controversial. The first line of psychosocial intervention in bipolar depression is psychoeducation, family-focused psychoeducation and cognitive-behavioral therapy. Electroconvulsive therapy and transcranial magnetic stimulation are options for refractory patients. Accumulated knowledge so far indicates that bipolar patients need continuous administration of an antimanic agent even during the acute depressive phase.
The development of rationalized 'combination treatment' guidelines is essential today, as it seems that the vast majority of patients do poorly on monotherapy and need complex pharmacotherapies. Although our knowledge is indeed limited, the development of some kind of guidelines for polypharmacy is possible and should be done as soon as possible.
本文旨在总结目前我们在双相抑郁治疗方面的知识和实践现状，并提出未来的研究方向。
目前我们充分了解锂盐在双相障碍各个阶段的有效性，以及其在预防自杀方面的特殊作用。某些第二代抗精神病药物有望成为治疗双相抑郁的有效选择，尽管目前相关数据有限。抗惊厥药似乎具有广泛的疗效，包括治疗混合性抑郁和快速循环发作。拉莫三嗪可能对治疗抑郁更有效，但对躁狂无效。抗抑郁药在双相抑郁中的作用存在争议。双相抑郁的一线心理社会干预措施是心理教育、以家庭为中心的心理教育和认知行为疗法。对于难治性患者，电抽搐治疗和经颅磁刺激是可选治疗方法。目前的研究结果表明，大多数双相患者在急性抑郁期也需要持续使用抗躁狂药物。
目前需要制定合理的“联合治疗”指南，因为大多数患者单药治疗效果不佳，需要复杂的药物治疗。尽管我们的知识确实有限，但制定某种多药治疗指南是可行的，并且应该尽快进行。
