Department of Psychiatry, Greater Los Angeles VA Healthcare System, Sepulveda Ambulatory Care Center, North Hills, CA 91343, USA.
Bipolar Disord. 2013 Aug;15(5):594-621. doi: 10.1111/bdi.12098. Epub 2013 Jul 19.
To examine the impact of psychotropic drugs on suicide and suicidal behaviors in bipolar disorders.
A Medline search of articles published from January 1960 to January 2013 was performed using relevant keywords to identify studies examining the relationship of psychotropic drugs to suicidal behaviors. The publications were further reviewed for relevant references and information. Additionally, the US Food and Drug Administration Center for Drug Evaluation Research website was searched.
The available studies used differing methodologies, making interpretation of the findings difficult. Studies suggest that antidepressants may increase suicidal risk in bipolar disorder, this possibly being related to the induction of broadly defined mixed states. There is no evidence that antiepileptic drugs as a class increase suicidal risk in patients with bipolar disorder. Only lithium provides convincing data that it reduces the risk of suicide over the long term. There is little known regarding the effects of antipsychotics, as well as anti-anxiety and hypnotic drugs, on suicidal behavior.
The available evidence for the impact of psychotropics on suicidal risk in patients with bipolar disorder is largely methodologically flawed and, except for a few instances, clinically not useful at this point. Adequately powered, prospective randomized controlled studies are needed to assess the impact of each class of psychotropic and each psychotropic as well as common combination therapies. Until such studies have been carried out, clinicians are urged to exercise caution in using these drugs and rely on the traditional means of carefully assessing and monitoring patients with bipolar disorder who are at high risk for suicide.
探讨精神药物对双相情感障碍患者自杀和自杀行为的影响。
使用相关关键词对 1960 年 1 月至 2013 年 1 月期间发表的文章进行 Medline 检索，以确定研究精神药物与自杀行为之间关系的文章。进一步查阅这些出版物的相关参考文献和信息。此外，还在 US Food and Drug Administration Center for Drug Evaluation Research 网站上进行了搜索。
现有研究采用了不同的方法学，使得对研究结果的解释变得困难。研究表明，抗抑郁药可能会增加双相情感障碍患者的自杀风险，这可能与广义定义的混合状态的诱导有关。没有证据表明抗癫痫药作为一类药物会增加双相情感障碍患者的自杀风险。只有锂有令人信服的数据表明，它可以长期降低自杀风险。关于抗精神病药以及抗焦虑和催眠药对自杀行为的影响，人们知之甚少。
目前关于精神药物对双相情感障碍患者自杀风险影响的证据在很大程度上存在方法学缺陷，并且除了少数情况外，目前在临床上没有实际意义。需要进行充分的、前瞻性的随机对照研究，以评估每一类精神药物以及每一种精神药物以及常见的联合治疗方案的影响。在进行这些研究之前，临床医生在使用这些药物时应谨慎，并依靠传统的方法，仔细评估和监测有自杀高风险的双相情感障碍患者。
