Bipolar Disorders Program, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain.
J Clin Psychiatry. 2012 Feb;73(2):e271-6. doi: 10.4088/JCP.11m07166.
Treatment of bipolar depression with antidepressants is strongly debated on the basis of the methodologically poor and insufficient data supporting their use and the widely held belief that antidepressants can induce new episodes of abnormal mood elevation or accelerate the rate of cycling. The present study aimed at identifying clinical risk factors for switch into hypomania, mania, or mixed states, within 8 weeks after introduction of an antidepressant or after increasing its dosage, in a prospective, longitudinal design.
221 consecutive DSM-IV-TR depressed bipolar I and II disorder patients were treated with antidepressants, which were added to previously prescribed mood stabilizers and/or atypical antipsychotics. No patient was on antidepressant monotherapy. The patients were enrolled from October 2005 through January 2010. The primary outcome was the assessment of switch to mania or hypomania within 8 weeks after the introduction or dose increase of an antidepressant. Both groups were compared with analysis of variance and χ² procedures.
Treatment-emergent affective switch was detected in 54 patients (24.4%) (switch group) while 167 patients (75.6%) (nonswitch group) did not experience a treatment-related switch. The main clinical differences significantly associated with the occurrence of an antidepressant-related switch, after performing logistic regression analysis, were higher rate of previous switches (P < .001) in the switch versus the nonswitch group, lower rate of responses to antidepressants (P < .001) in the switch versus the nonswitch group, and earlier age at onset (P = .026) in the switch versus the nonswitch group.
Bipolar patients with an earlier age at onset and an illness course characterized by lower rate of response to antidepressants and higher rate of switches into mania or hypomania were found to be the ones with higher switch risk. Nevertheless, a greater number of previous antidepressant exposures was not associated with the occurrence of an antidepressant-associated switch.
clinicaltrials.gov Identifier: NCT01503489.
抗抑郁药治疗双相抑郁症存在很大争议，这是基于支持其使用的方法学较差且数据不足，以及广泛认为抗抑郁药可能引发新的异常情绪升高或加速循环率的观点。本研究旨在通过前瞻性、纵向设计，确定在引入抗抑郁药或增加其剂量后 8 周内，出现轻躁狂、躁狂或混合状态转换的临床风险因素。
221 例连续 DSM-IV-TR 抑郁双相 I 型和 II 型障碍患者接受抗抑郁药治疗，同时添加先前处方的情绪稳定剂和/或非典型抗精神病药物。没有患者接受单一抗抑郁药治疗。患者于 2005 年 10 月至 2010 年 1 月入组。主要结局是评估在引入或增加抗抑郁药后 8 周内发生躁狂或轻躁狂的转换。采用方差分析和 χ²检验比较两组。
在 54 例患者（24.4%）（转换组）中发现治疗引起的情感转换，而 167 例患者（75.6%）（非转换组）未经历与治疗相关的转换。在进行逻辑回归分析后，与抗抑郁药相关的转换发生显著相关的主要临床差异是转换组的既往转换率较高（P<.001），转换组对抗抑郁药的反应率较低（P<.001），以及转换组的发病年龄较早（P=.026）。
发病年龄较早、对抗抑郁药反应率较低、躁狂或轻躁狂转换率较高的双相患者被发现具有较高的转换风险。然而，更多的既往抗抑郁药暴露与抗抑郁药相关转换的发生无关。
clinicaltrials.gov 标识符：NCT01503489。
