Saddichha Sahoo, Soy Ashish, Vibha Pandey
Department of Clinical Research, Emergency Management and Research Institute, Hyderabad-500014, India.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.06.2008.0107. Epub 2009 Feb 26.
Although there is sufficient evidence of manic switch induced by bupropion or electroconvulsive therapy (ECT) in bipolar depression, the evidence is not robust for unipolar recurrent depression. We present two patients with unipolar recurrent depression, with no family history of bipolarity or relevant personal medical history, who switched states while on a possible combination of bupropion and ECT. We believe that a hypersensitive state caused by ECT may have been aggravated by the dopamine synergistic action of bupropion, causing the switch. As current guidelines (American Psychiatric Association versus the National Institute for Health and Clinical Excellence) give contradictory advice regarding the treatment of patients with severe depression especially about combining pharmacotherapy and ECT, such patients need to be carefully evaluated before being treated with ECT.
尽管有充分证据表明，安非他酮或电休克疗法（ECT）可在双相抑郁中诱发躁狂转换，但在单相复发性抑郁中该证据并不充分。我们报告了两名单相复发性抑郁患者，他们没有双相情感障碍家族史或相关个人病史，却在接受可能联合使用安非他酮和ECT的治疗时出现了状态转换。我们认为，ECT引起的超敏状态可能因安非他酮的多巴胺协同作用而加重，从而导致了状态转换。由于目前的指南（美国精神病学协会与英国国家卫生与临床优化研究所）在重度抑郁症患者的治疗方面，尤其是在药物治疗与ECT联合使用方面给出了相互矛盾的建议，因此这类患者在接受ECT治疗前需要进行仔细评估。
