Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
J Clin Psychopharmacol. 2013 Jun;33(3):420-4. doi: 10.1097/JCP.0b013e31828ea89e.
We examined the effectiveness and mood conversion rate of fluoxetine monotherapy in patients with rapid cycling bipolar II depression versus patients with nonrapid cycling bipolar II depression. We hypothesized that there would be reduced antidepressant effectiveness and a greater mood conversion rate over time in patients with rapid cycling.
Open-label fluoxetine monotherapy 10 to 80 mg daily was administered for up to 14 weeks in 42 outpatients with rapid cycling versus 124 outpatients with nonrapid cycling. Outcome measures included the change over time in depression ratings, the proportion of treatment responders and remitters, change over time in mania ratings, and frequency of syndromal and subsyndromal hypomanic episodes.
There was a greater reduction in depression rating scores in the patients with rapid cycling versus those with nonrapid cycling (P = 0.04), with similar rates of response (P = 0.18) and remission (P = 0.69). Change in mean mania rating scores was similar in the patients with rapid cycling versus those with nonrapid cycling (P = 0.28). Hypomanic symptoms occurred in a similar proportion of the patients with rapid cycling versus those with nonrapid cycling (P = 0.99). Hypomanic episodes occurred in 5.4% (95% confidence interval [CI], 0.7-18.2) of the patients with rapid cycling versus 3.6% (95% CI, 1.0-8.9) of those with nonrapid cycling (P = 0.65). Subsyndromal hypomania occurred in 13.5% (95% CI, 4.5-28.8) of the patients with rapid cycling versus 9.0% (95% CI, 4.4-15.9) of those with nonrapid cycling (P = 0.43).
In contrast to reports of reduced effectiveness and increased mood conversion rates in patients with rapid cycling bipolar disorder taking antidepressants, we found greater effectiveness and similar hypomania rates during fluoxetine monotherapy in the patients with rapid cycling bipolar II depression versus those with nonrapid cycling bipolar II depression.
我们研究了氟西汀单药治疗快速循环型双相Ⅱ型抑郁与非快速循环型双相Ⅱ型抑郁患者的疗效和情绪转换率。我们假设快速循环型患者的抗抑郁疗效会降低，且情绪转换率会随时间的推移而增加。
42 例快速循环型和 124 例非快速循环型门诊患者接受为期 14 周的氟西汀单药治疗，剂量为 10 至 80mg/日。结局指标包括抑郁评分随时间的变化、治疗反应者和缓解者的比例、躁狂评分随时间的变化以及综合征和亚综合征轻躁狂发作的频率。
快速循环型患者的抑郁评分降低幅度大于非快速循环型患者（P=0.04），但反应率（P=0.18）和缓解率（P=0.69）相似。快速循环型与非快速循环型患者的平均躁狂评分变化相似（P=0.28）。快速循环型与非快速循环型患者发生轻躁狂症状的比例相似（P=0.99）。快速循环型患者发生轻躁狂发作的比例为 5.4%（95%可信区间，0.7-18.2），而非快速循环型患者为 3.6%（95%可信区间，1.0-8.9）（P=0.65）。快速循环型患者亚综合征性轻躁狂的发生率为 13.5%（95%可信区间，4.5-28.8），而非快速循环型患者为 9.0%（95%可信区间，4.4-15.9）（P=0.43）。
与抗抑郁药治疗快速循环型双相障碍患者疗效降低和情绪转换率增加的报道相反，我们发现氟西汀单药治疗快速循环型双相Ⅱ型抑郁患者的疗效更大，且轻躁狂发生率与非快速循环型双相Ⅱ型抑郁患者相似。
