Department of Psychiatry, Ludwig Maximilian University, Munich, Germany.
J Affect Disord. 2012 Feb;136(3):534-42. doi: 10.1016/j.jad.2011.10.033. Epub 2011 Nov 30.
Pharmacological treatment of bipolar depression is a complex and controversial issue, and its real-world practice remains largely unknown.
Observational analysis of the pharmacotherapy of 2231 psychiatric inpatients with a current episode of bipolar depression. The study was based on cross-sectional prescription data from European psychiatric hospitals that had been repeatedly collected between 1994 and 2009 through the collaborative Drug Safety in Psychiatry (AMSP) program.
Overall 81.3% of patients received antidepressants (AD) (7.8% monotherapy), 57.9% antipsychotics (AP), 50.1% anticonvulsants (AC), 47.5% tranquilizers, and 34.6% lithium (Li). Use over time was stable for AD, decreased for Li, and increased for AC, AP and tranquilizers. Pronounced increases were specifically observed for quetiapine, lamotrigine and valproate. Use of tricyclic AD decreased but its prevalence was still 11.8% in 2009. Venlafaxine was used by 19.5% in 2009. We also observed an increase of polypharmacy combining AD, AP, AC and Li. From 2006 to 2009 37.0% received concomitant treatment with three, and 6.4% even with all four of those drug classes.
Observational cross-sectional study without follow-up or additional clinical information.
Monotherapy with antidepressants and any use of tricyclic AD and venlafaxine still has a considerable prevalence in bipolar depression, but this is controversial due to the reported risk of treatment emergent affective switches. Triple and quadruple therapy is not evidence-based but increasingly used in clinical practice. This may reflect an attempt to overcome treatment failure, and further studies should evaluate efficacy and safety of this common practice.
双相抑郁的药物治疗是一个复杂且有争议的问题，其真实世界的治疗实践仍知之甚少。
对 2231 例当前发作双相抑郁的精神科住院患者进行药物治疗的观察性分析。该研究基于欧洲精神病院的横断面处方数据，这些数据通过合作的精神药理学药物安全（AMSP）项目于 1994 年至 2009 年期间反复收集。
总体上，81.3%的患者接受了抗抑郁药（AD）（7.8%为单药治疗）、57.9%的抗精神病药（AP）、50.1%的抗惊厥药（AC）、47.5%的镇静剂和 34.6%的锂（Li）。随着时间的推移，AD 的使用保持稳定，Li 的使用减少，AC、AP 和镇静剂的使用增加。喹硫平、拉莫三嗪和丙戊酸的使用显著增加。三环类 AD 的使用减少，但在 2009 年仍占 11.8%。文拉法辛在 2009 年的使用率为 19.5%。我们还观察到抗抑郁药、抗精神病药、抗惊厥药和 Li 联合使用的联合用药增加。从 2006 年到 2009 年，37.0%的患者接受了三种药物的联合治疗，6.4%的患者甚至接受了所有四种药物的联合治疗。
无随访或其他临床信息的观察性横断面研究。
抗抑郁药单药治疗以及任何使用三环类 AD 和文拉法辛在双相抑郁中仍有相当大的比例，但由于治疗后出现情感转换的风险，这是有争议的。三联和四联疗法没有循证医学证据，但在临床实践中越来越多地使用。这可能反映了试图克服治疗失败的尝试，进一步的研究应该评估这种常见做法的疗效和安全性。
