Department of Psychiatry and Neuroscience Program, Harvard Medical School and McLean Division of Massachusetts General Hospital, Boston, MA, USA.
Acta Psychiatr Scand. 2010 Jun;121(6):404-14. doi: 10.1111/j.1600-0447.2009.01514.x. Epub 2009 Dec 2.
To review available data pertaining to risk of mania-hypomania among bipolar (BPD) and major depressive disorder (MDD) patients with vs. without exposure to antidepressant drugs (ADs) and consider effects of mood stabilizers.
Computerized searching yielded 73 reports (109 trials, 114 521 adult patients); 35 were suitable for random effects meta-analysis, and multivariate-regression modeling included all available trials to test for effects of trial design, AD type, and mood-stabilizer use.
The overall risk of mania with/without ADs averaged 12.5%/7.5%. The AD-associated mania was more frequent in BPD than MDD patients, but increased more in MDD cases. Tricyclic antidepressants were riskier than serotonin-reuptake inhibitors (SRIs); data for other types of ADs were inconclusive. Mood stabilizers had minor effects probably confounded by their preferential use in mania-prone patients.
Use of ADs in adults with BPD or MDD was highly prevalent and moderately increased the risk of mania overall, with little protection by mood stabilizers.
回顾有关双相情感障碍（BPD）和重度抑郁症（MDD）患者在使用与未使用抗抑郁药物（ADs）情况下出现躁狂-轻躁狂风险的现有数据，并探讨情绪稳定剂的影响。
计算机检索得到 73 份报告（109 项试验，114521 名成年患者）；35 项适合进行随机效应荟萃分析，多变量回归模型纳入了所有可用的试验，以测试试验设计、AD 类型和情绪稳定剂使用的影响。
AD 治疗与未治疗的躁狂总风险分别为 12.5%和 7.5%。BPD 患者的 AD 相关躁狂发生率高于 MDD 患者，但 MDD 患者的发生率增加更多。三环类抗抑郁药比 5-羟色胺再摄取抑制剂（SRIs）更危险；其他类型 AD 的数据尚无定论。情绪稳定剂的效果较小，可能与其在易发生躁狂的患者中优先使用有关。
AD 在 BPD 或 MDD 成年患者中的使用非常普遍，总体上中度增加了躁狂的风险，而情绪稳定剂的保护作用很小。
