Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2150 Pennsylvania Ave., NW, Washington, DC 20037, USA.
J Addict Dis. 2009 Oct;28(4):348-55. doi: 10.1080/10550880903182994.
Antidepressant use in the treatment of bipolar disorder is controversial due the risks of affective switching and cycle acceleration. Studies of non-comorbid samples suggest that the risk can be mitigated with the use of a concomitant mood stabilizer. However, the majority of patients with bipolar disorder will experience a comorbid substance use disorder and little is known about these individuals because they are typically excluded from clinical trials. Patients entering a substance abuse treatment program who had a history of bipolar disorder were interviewed to evaluate antidepressant-induced affective switching with and without concomitant mood stabilizer. Among 41 comorbid participants, the total lifetime antidepressant-induced switch rate was 76%. The switch rate was 56% for patients taking a mood stabilizer and an antidepressant concomitantly. There was no difference between patients with bipolar I and bipolar II disorders.
抗抑郁药在双相情感障碍治疗中的应用存在争议，因为存在情感转换和周期加速的风险。非共病样本的研究表明，使用伴随的情绪稳定剂可以降低这种风险。然而，大多数双相情感障碍患者将经历共病物质使用障碍，对于这些个体知之甚少，因为他们通常被排除在临床试验之外。进入物质滥用治疗项目的、有双相情感障碍病史的患者接受了访谈，以评估伴随和不伴随情绪稳定剂的抗抑郁药引起的情感转换。在 41 名共病参与者中，终生抗抑郁药引起的转换率为 76%。同时服用情绪稳定剂和抗抑郁药的患者的转换率为 56%。双相 I 型和双相 II 型障碍患者之间没有差异。
