双相情感障碍与补充医学：当前证据、安全性问题与临床考虑。

Bipolar disorder and complementary medicine: current evidence, safety issues, and clinical considerations.

机构信息

Department of Psychiatry, Faculty of Medicine, The University of Melbourne, The Melbourne Clinic, Melbourne, Victoria, Australia.

出版信息

J Altern Complement Med. 2011 Oct;17(10):881-90. doi: 10.1089/acm.2010.0481.

DOI:10.1089/acm.2010.0481

PMID:22010777

Abstract

BACKGROUND

Bipolar disorder (BD) is a debilitating syndrome that is often undiagnosed and undertreated. Population surveys show that persons with BD often self-medicate with complementary and alternative medicine (CAM) or integrative therapies in spite of limited research evidence supporting their use. To date, no review has focused specifically on nonconventional treatments of BD.

OBJECTIVES

The study objectives were to present a review of nonconventional (complementary and integrative) interventions examined in clinical trials on BD, and to offer provisional guidelines for the judicious integrative use of CAM in the management of BD.

METHODS

PubMed, CINAHL,(®) Web of Science, and Cochrane Library databases were searched for human clinical trials in English during mid-2010 using Bipolar Disorder and CAM therapy and CAM medicine search terms. Effect sizes (Cohen's d) were also calculated where data were available.

RESULTS

Several positive high-quality studies on nutrients in combination with conventional mood stabilizers and antipsychotic medications in BD depression were identified, while branched-chain amino acids and magnesium were effective (small studies) in attenuating mania in BD. In the treatment of bipolar depression, evidence was mixed regarding omega-3, while isolated studies provide provisional support for a multinutrient formula, n-acetylcysteine, and l-tryptophan. In one study, acupuncture was found to have favorable but nonsignificant effects on mania and depression outcomes.

CONCLUSIONS

Current evidence supports the integrative treatment of BD using combinations of mood stabilizers and select nutrients. Other CAM or integrative modalities used to treat BD have not been adequately explored to date; however, some early findings are promising. Select CAM and integrative interventions add to established conventional treatment of BD and may be considered when formulating a treatment plan. It is hoped that the safety issues and clinical considerations addressed in this article may encourage the practice of safety-conscious and evidence-based integrative management of BD.

摘要

背景

双相情感障碍（BD）是一种使人衰弱的综合征，常被漏诊和治疗不足。人群调查显示，尽管支持其使用的研究证据有限，BD 患者通常会自行使用补充和替代医学（CAM）或综合疗法进行治疗。迄今为止，尚无专门针对 BD 的非传统治疗方法的综述。

目的

本研究旨在综述临床试验中检查的非传统（补充和综合）干预措施，并为明智地将 CAM 整合到 BD 的管理中提供临时指南。

方法

在 2010 年年中，使用“双相情感障碍”和“CAM 疗法”和“CAM 医学”搜索词，在 PubMed、CINAHL、® Web of Science 和 Cochrane Library 数据库中以英文搜索人类临床试验。在有数据的情况下，还计算了效应大小（Cohen's d）。

结果

在 BD 抑郁症中，发现了几项关于营养物质与常规心境稳定剂和抗精神病药物联合使用的高质量阳性研究，而支链氨基酸和镁在减轻 BD 躁狂方面是有效的（小型研究）。在治疗双相抑郁方面，关于 ω-3 的证据喜忧参半，而孤立的研究为多种营养素配方、N-乙酰半胱氨酸和 L-色氨酸提供了临时支持。在一项研究中，发现针灸对躁狂和抑郁结局有有利但无统计学意义的影响。

结论

目前的证据支持使用心境稳定剂和精选营养素联合治疗 BD。其他用于治疗 BD 的 CAM 或综合疗法尚未得到充分探索；然而，一些早期发现很有希望。一些 CAM 和综合干预措施补充了既定的传统 BD 治疗方法，在制定治疗计划时可以考虑这些方法。希望本文中讨论的安全性问题和临床注意事项能够鼓励以安全意识和基于证据的方式进行 BD 的综合管理。