Henry C
Université Paris 12, Faculté de Médecine, IFR10, Créteil, F-94000.
Encephale. 2009 Dec;35 Suppl 7:S261-3. doi: 10.1016/S0013-7006(09)73482-7.
Bipolar depressions can present all the clinical aspects from a major depressive episode with a mild intensity to severe one. However, part of this severity comes from the bipolarity by itself. Bipolar disorders belong to the 10 most disabling conditions in the world. Moreover, the complexity of bipolar depressions comes also from the complexity to treat them. Antidepressants are difficult to use in bipolar subjects because the risk of switch, the possible induction of rapid cycles or of a chronic dysphoric state. Currently, guidelines are not very helpful for the choice of the treatment in case of an acute major depressive disorder. Indeed, the current guidelines give the choice between a mood stabilizer alone or associated with an antidepressant, either between an antipsychotic more or less associated with an antidepressant. A better understanding of the clinical heterogeneity of bipolar depression could help to solve a part of this complexity.
双相抑郁可呈现从轻度到重度的各种临床症状，涵盖从轻度的重度抑郁发作到严重的重度抑郁发作的所有临床情况。然而，这种严重程度部分源于双相情感障碍本身。双相情感障碍属于世界上十大致残性疾病之一。此外，双相抑郁的复杂性还源于治疗的复杂性。抗抑郁药在双相情感障碍患者中难以使用，因为存在转相风险、可能诱发快速循环或慢性烦躁状态。目前，对于急性重度抑郁障碍的治疗选择，指南的帮助不大。事实上，当前指南提供了单独使用心境稳定剂或与抗抑郁药联合使用的选择，以及或多或少与抗抑郁药联合使用抗精神病药物的选择。更好地理解双相抑郁的临床异质性有助于解决部分此类复杂性问题。
