Chang Jae Seung, Ha Kyooseob
Department of Psychiatry and Behavioral Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
Indian J Psychol Med. 2011 Jan;33(1):11-7. doi: 10.4103/0253-7176.85390.
Patients with bipolar disorder spend more time in a depressed than manic state, even with individualized treatment. To date, bipolar depression is often misdiagnosed and ineffectively managed both for acute episodes and residual symptoms. This review attempts to summarize the current status of available treatment strategies in the treatment of bipolar depression. For acute and prophylactic treatment, a substantial body of evidence supports the antidepressive efficacy of lithium for bipolar disorders and its antisuicidal effects. Among numerous anticonvulsants with mood-stabilizing properties, valproate and lamotrigine could be first-line options for bipolar depression. Due to receptor profile, mood-stabilizing properties of second-generation antipsychotics have been explored, and up to date, quetiapine and olanzapine appear to be a reasonable option for bipolar depression. The usefulness of antidepressants in bipolar depression is still controversial. Current guidelines generally recommend the cautious antidepressant use in combination with mood stabilizers to reduce the risk of mood elevation or cycle acceleration. Results from clinical trials on psychosocial intervention are promising, especially when integrated with pharmacotherapy. Most patients with bipolar depression need individualized and combined treatment, although the published evidence on this type of treatment strategy is limited. Future studies on the utility of currently available agents and modalities including psychosocial intervention are required.
双相情感障碍患者处于抑郁状态的时间比躁狂状态更长，即便接受个体化治疗也是如此。迄今为止，双相抑郁在急性发作期和残留症状期常常被误诊，且治疗效果不佳。本综述旨在总结双相抑郁现有治疗策略的现状。对于急性治疗和预防性治疗，大量证据支持锂盐对双相情感障碍的抗抑郁疗效及其抗自杀作用。在众多具有心境稳定特性的抗惊厥药中，丙戊酸盐和拉莫三嗪可能是双相抑郁的一线选择。由于受体特性，已对第二代抗精神病药物的心境稳定特性进行了探索，目前，喹硫平和奥氮平似乎是双相抑郁的合理选择。抗抑郁药在双相抑郁中的作用仍存在争议。当前指南普遍建议谨慎使用抗抑郁药并联合心境稳定剂，以降低心境高涨或发作周期加速的风险。心理社会干预的临床试验结果很有前景，尤其是与药物治疗相结合时。大多数双相抑郁患者需要个体化和联合治疗，尽管关于这种治疗策略的已发表证据有限。需要对包括心理社会干预在内的现有药物和治疗方式的效用进行进一步研究。
