Clinical Research, NeuroResearch Clinics, Inc., 1008 Dolphin Drive, Cape Coral, FL, USA.
Neuropsychiatr Dis Treat. 2010 Nov 9;6:741-7. doi: 10.2147/NDT.S14353.
A novel method for differentiating and treating bipolar disorder cycling on the depressive pole from patients who are suffering a major depressive episode is explored in this work. To confirm the diagnosis of type 1 or type 2 bipolar disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria require that at least one manic or hypomanic episode be identified. History of one or more manic or hypomanic episodes may be impossible to obtain, representing a potential blind spot in the DSM-IV diagnostic criteria. Many bipolar patients who cycle primarily on the depressive side for many years carry a misdiagnosis of recurrent major depression, leading to treatment with antidepressants that achieve little or no relief of symptoms. This article discusses a novel approach for diagnosing and treating patients with bipolar disorder cycling on the depressive pole versus patients with recurrent major depression.
Patients involved in this study were formally diagnosed with recurrent major depression under DSM-IV criteria and had no medical history of mania or hypomania to support the diagnosis of bipolar disorder. All patients had suffered multiple depression treatment failures in the past, when evaluated under DSM-IV guidelines, secondary to administration of antidepressant drugs and/or serotonin with dopamine amino acid precursors.
This study contained 1600 patients who were diagnosed with recurrent major depression under the DSM-IV criteria. All patients had no medical history of mania or hypomania. All patients experienced no relief of depression symptoms on level 3 amino acid dosing values of the amino acid precursor dosing protocol. Of 1600 patients studied, 117 (7.3%) nonresponder patients were identified who experienced no relief of depression symptoms when the serotonin and dopamine amino acid precursor dosing values were adjusted to establish urinary serotonin and urinary dopamine levels in the Phase III therapeutic ranges. All of the 117 nonresponders who achieved no relief of depression symptoms were continued on this amino acid dosing value, and a mood-stabilizing drug was started. At this point, complete relief of depression symptoms, under evaluation with DSM-IV criteria, was noted in 114 patients within 1-5 days. With further dose adjustment of the mood-stabilizing drug, the remaining three nonresponders achieved relief of depression symptoms.
Resolution of depression symptoms with the addition of a mood-stabilizing drug in combination with proper levels of serotonin and dopamine amino acid precursors was the basis for a clinical diagnosis of bipolar disorder cycling on the depressive pole.
本研究探索了一种新方法，用于区分和治疗在抑郁期出现双相障碍循环的患者和患有重度抑郁症发作的患者。根据《精神障碍诊断与统计手册》（DSM-IV）标准，要确诊为 1 型或 2 型双相障碍，需要确定至少有一次躁狂或轻躁狂发作。躁狂或轻躁狂发作的病史可能无法获得，这是 DSM-IV 诊断标准中的一个潜在盲点。许多主要在抑郁期循环多年的双相患者被误诊为复发性重度抑郁症，导致使用抗抑郁药治疗，症状几乎没有或没有得到缓解。本文讨论了一种新的方法，用于诊断和治疗在抑郁期循环的双相障碍患者与复发性重度抑郁症患者。
参与本研究的患者根据 DSM-IV 标准被正式诊断为复发性重度抑郁症，且无躁狂或轻躁狂病史支持双相障碍的诊断。所有患者过去曾多次因服用抗抑郁药和/或 5-羟色胺与多巴胺氨基酸前体而治疗失败，根据 DSM-IV 指南评估。
本研究包含 1600 名根据 DSM-IV 标准诊断为复发性重度抑郁症的患者。所有患者均无躁狂或轻躁狂病史。所有患者在氨基酸前体给药方案的氨基酸前体剂量 3 级时，均未出现抑郁症状缓解。在 1600 名研究患者中，有 117 名（7.3%）无反应患者被确定为在调整 5-羟色胺和多巴胺氨基酸前体剂量以建立 III 期治疗范围内的尿 5-羟色胺和尿多巴胺水平时，无抑郁症状缓解。所有无反应的 117 名患者继续使用这种氨基酸剂量，然后开始使用情绪稳定剂。此时，根据 DSM-IV 标准评估，114 名患者在 1-5 天内完全缓解抑郁症状。通过进一步调整情绪稳定剂的剂量，其余 3 名无反应者也缓解了抑郁症状。
在适当的 5-羟色胺和多巴胺氨基酸前体水平上，添加情绪稳定剂可缓解抑郁症状，这是在抑郁期出现双相障碍循环的临床诊断依据。
