Bipolar Disorders Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
J Affect Disord. 2011 Mar;129(1-3):14-26. doi: 10.1016/j.jad.2010.05.018. Epub 2010 Jun 9.
Bipolar depression poses a great burden on patients and their families due to its duration, associated functional impairment, and limited treatment options. Given the complexity of the disorder and the advances in treatment, a number of clinical guidelines, consensus statements and expert opinions were developed with the aim to standardize treatment and provide clinicians with treatment algorithms for every-day clinical practice. Unfortunately, they often led to conflicting conclusions and recommendations due to limitations of the available literature. As findings emerge from research literature, guidelines quickly become obsolete and need to be updated or revised. Many guidelines have been updated in the last 5 years, after the last review of bipolar disorder (BD) treatment guidelines.
The purpose of this work is to systematically review guidelines, consensus meetings and treatment algorithms on the acute treatment of bipolar depression updated or published since 2005, to critically underline common and critical points, highlight limits and strengths, and provide a starting point for future research
The MEDLINe/PubMed/Index Medicus, PsycINFO/PsycLIT, Excerpta Medica/EMBASE, databases were searched using "depression", "bipolar", "manic-depression", "manic-depressive" and "treatment guidelines" as key words
The search returned 204 articles. Amongst them, there were 28 papers concerning structured treatment algorithms and/or guidelines suggested by official panels. After excluding those guidelines that were not performed by scientific societies or international groups and those published before 2005, the final selection yielded 7 papers When looking into guidelines content, the results indicate a trend to the gradual acceptance of the use of the atypical antipsychotic quetiapine as monotherapy as first-line treatment. Antidepressant monotherapy is discouraged in most of them, although some support the use of antidepressants in combination with antimanic agents for a limited period of time. Lamotrigine has become a highly controversial option.
The management of bipolar depression is complex and should be differentiated from management of unipolar depression. Guidelines may be useful instruments for helping clinicians to choose and plan bipolar depression treatment by integrating the more updated scientific knowledge with every-day clinical practice and patient-specific factors; however, a further effort is needed in order to improve guidelines implementation in clinical practice. The latest updates on treatment guidelines for bipolar depression give priority to novel treatment approaches, such as quetiapine, over more traditional ones, such as lithium or antidepressants. Lamotrigine is a controversial option.
由于其持续时间、相关功能障碍和有限的治疗选择，双相抑郁症给患者及其家属带来了巨大的负担。鉴于该疾病的复杂性和治疗的进步，制定了许多临床指南、共识声明和专家意见，旨在使治疗标准化，并为临床医生提供日常临床实践的治疗算法。不幸的是，由于现有文献的局限性，它们往往导致相互矛盾的结论和建议。随着研究文献中出现新的发现，指南很快就会过时，需要更新或修订。许多指南在过去 5 年中进行了更新，这是在最后一次审查双相情感障碍（BD）治疗指南之后。
本工作的目的是系统地回顾自 2005 年以来更新或发布的关于双相抑郁症急性治疗的指南、共识会议和治疗算法，批判性地强调共同点和关键点，突出局限性和优势，并为未来的研究提供起点。
使用“depression”、“bipolar”、“manic-depression”、“manic-depressive”和“treatment guidelines”作为关键词，在 MEDLINe/PubMed/Index Medicus、PsycINFO/PsycLIT、Excerpta Medica/EMBASE 数据库中进行搜索。
搜索返回了 204 篇文章。其中，有 28 篇文章涉及由官方小组提出的结构化治疗算法和/或指南。在排除那些不是由科学协会或国际组织制定的、以及那些在 2005 年之前发布的指南之后，最终选择的结果为 7 篇。当研究指南的内容时，结果表明存在一种逐渐接受使用非典型抗精神病药喹硫平作为一线治疗的单相治疗的趋势。在大多数指南中，不鼓励使用抗抑郁药单药治疗，尽管有些指南支持在有限的时间内使用抗抑郁药与抗躁狂药物联合使用。拉莫三嗪已成为一个极具争议的选择。
双相抑郁症的管理很复杂，应与单相抑郁症的管理区分开来。指南可以作为有用的工具，帮助临床医生通过整合最新的科学知识与日常临床实践和患者特定因素来选择和计划双相抑郁症的治疗；然而，需要进一步努力以改善指南在临床实践中的实施。关于双相抑郁症治疗指南的最新更新优先考虑新型治疗方法，如喹硫平，而不是更传统的方法，如锂或抗抑郁药。拉莫三嗪是一个有争议的选择。
