Department of Neuroscience, Palermo University, Buenos Aires, Argentina.
Pharmacopsychiatry. 2011 Jan;44(1):21-6. doi: 10.1055/s-0030-1265198. Epub 2010 Oct 28.
Since there is considerable uncertainty about therapeutic responses to antidepressants among depressed patients diagnosed with bipolar (BP) vs. unipolar (UP) mood disorders, we have reviewed available studies that compared both types of depressed patients.
Extensive computerized literature-searching identified reports of antidepressant studies involving both BP and UP depressed patients. We used random-effects meta-analysis to compare short-term drug responses by patient type, as well as meta-regression modeling for effects of selected covariates.
We identified only 10 studies meeting even liberal inclusion criteria, and they varied greatly in size and design quality. The overall difference in antidepressant responses between BP (n=863) and UP (n=2 226) disorder patients was not significant (pooled RR=1.05; CI: 0.96-1.15; P=0.34). Based on meta-regression, we also found no difference in responses based on diagnosis or subtype, subjects/study, % women, average age, or length of treatment based on meta-regression. Risk of manic-switching averaged 2.50 vs. 0.275%/week among BP vs. UP disorder patients, including co-treatment with mood stabilizers in 70% of BP patients.
The findings suggest little difference in antidepressant responses by diagnostic type, sex, or other factors considered, but a substantial risk of mania and hypomania with BP disorders. However, data pertaining to the fundamental question of antidepressant response among BP vs. UP depressed patients were strikingly limited, and support only tentative conclusions. Additional, well-designed, prospective trials of matched BP and UP depression patients and controlled treatment are required.
由于双相（BP）与单相（UP）心境障碍患者的抗抑郁治疗反应存在相当大的不确定性，因此我们回顾了比较这两种类型的抑郁患者的现有研究。
广泛的计算机文献检索确定了涉及 BP 和 UP 抑郁患者的抗抑郁药物研究报告。我们使用随机效应荟萃分析比较了患者类型的短期药物反应，并进行了元回归模型以评估选定协变量的影响。
我们仅确定了 10 项符合甚至宽松纳入标准的研究，这些研究在规模和设计质量上差异很大。BP（n=863）和 UP（n=2226）障碍患者的抗抑郁反应总体差异无统计学意义（汇总 RR=1.05；95%CI：0.96-1.15；P=0.34）。基于元回归，我们还发现基于诊断或亚型、研究对象/数量、女性比例、平均年龄或基于元回归的治疗持续时间，反应没有差异。BP 与 UP 障碍患者的躁狂转换风险平均分别为 2.50%和 0.275%/周，其中 70%的 BP 患者联合使用心境稳定剂。
研究结果表明，诊断类型、性别或其他考虑因素对抗抑郁反应的差异较小，但 BP 障碍患者有明显的躁狂和轻躁狂风险。然而，关于 BP 与 UP 抑郁患者抗抑郁反应的基本问题的数据极为有限，仅支持初步结论。需要进一步设计良好、前瞻性、匹配的 BP 和 UP 抑郁患者的试验和对照治疗。
