Samalin L, Nourry A, Llorca P-M
CHU Clermont-Ferrand, BP 69, Clermont-Ferrand cedex 01, France.
Encephale. 2011 Dec;37 Suppl 3:S203-8. doi: 10.1016/S0013-7006(11)70054-9.
For decades, lithium and anticonvulsants have been widely used in the treatment of bipolar disorder. Their efficacy in the treatment of mania is recognized. These drugs have been initially evaluated in old and methodologically heterogeneous studies. Their efficacy in bipolar depression has not always been confirmed in more recent and methodologically more reliable studies. Thus, lithium's efficacy as monotherapy was challenged by the study of Young (2008) that showed a lack of efficacy compared with placebo in the treatment of bipolar depression. In two recent meta-analyses, valproate has shown a modest efficacy in the treatment of bipolar depression. As for lithium, valproate appeared to have a larger antimanic effect for acute phase and prophylaxis of bipolar disorder. In contrast, lamotrigine is more effective on the depressive pole of bipolar disorder with better evidence for the prevention of depressive recurrences. The guidelines include these recent studies and recommend lamotrigine as a first-line treatment of bipolar depression and for maintenance treatment. Because of more discordant data concerning lithium and valproate, these two drugs are placed either as first or as second line treatment of bipolar depression. The different safety/efficacy ratios of mood stabilizers underlie the complementarity and the importance of combination between them, or with some second-generation antipsychotics, in the treatment of patients with bipolar disorder.
几十年来，锂盐和抗惊厥药物一直广泛用于双相情感障碍的治疗。它们在治疗躁狂发作方面的疗效已得到认可。这些药物最初是在年代久远且方法各异的研究中进行评估的。在更新的、方法学上更可靠的研究中，它们在双相抑郁治疗中的疗效并非总能得到证实。因此，Young（2008年）的研究对锂盐作为单一疗法的疗效提出了质疑，该研究表明，在双相抑郁治疗中，与安慰剂相比，锂盐缺乏疗效。在最近的两项荟萃分析中，丙戊酸盐在双相抑郁治疗中显示出一定疗效。与锂盐一样，丙戊酸盐在双相情感障碍的急性期治疗和预防方面似乎具有更大的抗躁狂作用。相比之下，拉莫三嗪对双相情感障碍的抑郁相更有效，在预防抑郁复发方面有更充分的证据。这些指南纳入了这些最新研究，并推荐拉莫三嗪作为双相抑郁的一线治疗药物及维持治疗药物。由于关于锂盐和丙戊酸盐的数据存在更多不一致之处，这两种药物在双相抑郁治疗中被列为一线或二线治疗药物。心境稳定剂不同的安全性/疗效比是它们之间以及与某些第二代抗精神病药物联合使用在双相情感障碍患者治疗中具有互补性和重要性的基础。
