McIntyre Roger S, Alsuwaidan Mohammad, Goldstein Benjamin I, Taylor Valerie H, Schaffer Ayal, Beaulieu Serge, Kemp David E
Mood Disorders Psychopharmacology Unit, University Health Network, Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario, Canada.
Ann Clin Psychiatry. 2012 Feb;24(1):69-81.
One goal of the Canadian Network for Mood and Anxiety Treatments (CANMAT) is to develop evidence-based and best practice educational programs and recommendations. Our group conducted a comprehensive literature review to provide evidence-based recommendations for treating metabolic comorbidity in individuals with major depressive disorder (MDD) and bipolar disorder (BD).
We searched PubMed for all English-language articles published January 1966 to November 2010 using BD and MDD cross-referenced with metabolic syndrome, obesity, diabetes mellitus, hypertension, and dyslipidemia. That search was augmented by a review of articles reporting outcomes of an intervention targeting components of metabolic syndrome in individuals with MDD or BD.
Consensus exists for the recommendation that individuals with MDD and BD should be routinely screened for risk factors that increase risk for metabolic syndrome. For excess weight, the best-studied pharmacologic approaches are metformin and topiramate, with emerging evidence for liraglutide and modafinil. For binge eating disorder, the best evidence in mood disorders was for cognitive-behavioral therapy as well as topiramate, zonisamide, and in select cases selective serotonin reuptake inhibitors. For dysglycemia, dyslipidemia, and hypertension, evidence supports cognitive-behavioral interventions and anti-diabetic, antilipidemic, and antihypertensive treatments.
Comprehensive care of individuals with mood disorders should include routine evaluation of the risk and presence of metabolic syndrome and its components. Systematic evaluation of preventative and targeted treatments of metabolic syndrome in mood disorder populations is insufficient.
加拿大情绪与焦虑治疗网络（CANMAT）的目标之一是制定基于证据的最佳实践教育项目和建议。我们的团队进行了一项全面的文献综述，以提供针对治疗重度抑郁症（MDD）和双相情感障碍（BD）患者代谢合并症的循证建议。
我们在PubMed上检索了1966年1月至2010年11月发表的所有英文文章，使用BD和MDD与代谢综合征、肥胖、糖尿病、高血压和血脂异常进行交叉检索。通过回顾报告针对MDD或BD患者代谢综合征组成部分的干预结果的文章对该检索进行了补充。
对于MDD和BD患者应常规筛查增加代谢综合征风险的危险因素这一建议已达成共识。对于超重，研究最多的药物治疗方法是二甲双胍和托吡酯，有新证据支持利拉鲁肽和莫达非尼。对于暴饮暴食症，情绪障碍方面的最佳证据是认知行为疗法以及托吡酯、唑尼沙胺，在某些情况下还有选择性5-羟色胺再摄取抑制剂。对于血糖异常、血脂异常和高血压，证据支持认知行为干预以及抗糖尿病、抗血脂和抗高血压治疗。
情绪障碍患者的综合护理应包括对代谢综合征及其组成部分的风险和存在情况进行常规评估。对情绪障碍人群代谢综合征的预防和靶向治疗的系统评估不足。
