Department of Psychiatry,Faulkner Hospital, Boston, MA 02130,
Harv Rev Psychiatry. 2010 Jan-Feb;18(1):36-55. doi: 10.3109/10673220903523524.
This updated version of the bipolar depression algorithm of the Psychopharmacology Algorithm Project at the Harvard South Shore Program aims to provide an organized, sequential, and evidence-supported approach for the treatment of that disorder. After initial evaluation and diagnosis, the psychiatrist should first assess whether there is an urgent indication for ECT. If ECT is not indicated, and the patient has psychotic symptoms, then an antipsychotic should be part of the medication regimen. Next, if the patient is not currently treated with mood stabilizers, there is a slight preference for lithium. If lithium is not effective or tolerated, treatment with quetiapine or lamotrigine should be initiated. If the patient is currently taking other mood stabilizers, their dosage should be optimized, and the clinician should consider adding or switching to lithium, quetiapine, or lamotrigine. Next, if the patient is not at especially high risk of mood destabilization, an antidepressant can be added in the bipolar depressed patient who has failed trials of lithium, quetiapine, and lamotrigine. Rapid-cycling depressed patients may require combinations of two or three mood stabilizers. ECT, along with other psychopharmacological options, could be reconsidered for the treatment of refractory bipolar depressed patients.
哈佛南岸项目精神药理学算法项目的双相抑郁算法更新版旨在为该疾病的治疗提供一种有组织、有序和有证据支持的方法。在初步评估和诊断后，精神科医生应首先评估是否有急诊电休克治疗的指征。如果不适合电休克治疗，且患者有精神病症状，则应将抗精神病药物纳入药物治疗方案。接下来，如果患者目前未使用心境稳定剂治疗，则应轻度倾向于使用锂盐。如果锂盐无效或不耐受，应开始使用喹硫平或拉莫三嗪治疗。如果患者目前正在使用其他心境稳定剂，则应优化其剂量，并考虑加用或换用锂盐、喹硫平或拉莫三嗪。接下来，如果患者没有特别高的情绪不稳定风险，且在锂盐、喹硫平、拉莫三嗪治疗失败的双相抑郁患者中，可以加用抗抑郁药。快速循环抑郁患者可能需要两种或三种心境稳定剂的联合治疗。对于难治性双相抑郁患者，可以重新考虑电休克治疗以及其他精神药理学选择。
