Mayo Clinic Depression Center, Department of Psychiatry & Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Universidad de los Andes, Facultad de Medicina, Departamento de Psiquiatría, Santiago, Chile.
J Affect Disord. 2014 Dec;169 Suppl 1:S17-23. doi: 10.1016/S0165-0327(14)70005-9.
Depression is the predominant pole of illness disability in bipolar disorder and, compared with acute mania, has less systematic research guiding treatment development. The aim of this review is to present the therapeutic options currently available for managing bipolar depression and to highlight areas of unmet need and future research.
Literature search of PubMed, PsycINFO, and Cochrane databases and bibliographies from 2000 to August 2013 for treatments that have regulatory approval for bipolar depression or early controlled preliminary data on efficacy.
Treatment options for bipolar depression have increased over the last decade, most notably with regulatory approval for olanzapine/fluoxetine combination, quetiapine, and lurasidone. Conventional mood stabilizers lamotrigine and divalproex have meta-analyses suggesting acute antidepressant response. Manual-based psychotherapies also appear to be effective in treating bipolar depression. The therapeutic utility of unimodal antidepressants, as a class, for the treatment of patients with bipolar depression, as a group, remains to be confirmed. There is a substantially unmet need to develop new interventions that are efficacious, effective, and have low side effect burden.
Additional compounds are currently being developed that may ultimately be applicable to the treatment of bipolar depression and early open-trial data encourage further studies, but both of these topics are beyond the scope of this review.
Future registrational trials will need to establish initial efficacy, but increasing interest for personalized or individualized medicine will encourage further studies on individual predictors or biomarkers of response.
在双相情感障碍中，抑郁是疾病致残的主要方面，与急性躁狂相比，针对其治疗开发的系统研究较少。本综述旨在介绍目前可用于治疗双相抑郁的治疗选择，并强调未满足的需求领域和未来的研究方向。
从 2000 年到 2013 年 8 月，对PubMed、PsycINFO 和 Cochrane 数据库以及文献的参考文献进行了文献检索，以寻找针对双相抑郁具有监管批准或早期有疗效的初步对照数据的治疗方法。
过去十年中，双相抑郁的治疗选择有所增加，尤其是奥氮平/氟西汀联合制剂、喹硫平和鲁拉西酮获得了监管批准。传统的心境稳定剂拉莫三嗪和丙戊酸钠有荟萃分析表明其具有急性抗抑郁作用。基于手册的心理治疗方法似乎也对治疗双相抑郁有效。作为一类药物，单模态抗抑郁药治疗双相抑郁患者的疗效仍有待证实。仍有大量的需求有待开发有效、有效且副作用低的新干预措施。
目前正在开发其他化合物，这些化合物最终可能适用于治疗双相情感障碍，早期开放试验数据鼓励进一步研究，但这两个主题都超出了本综述的范围。
未来的注册试验将需要确定初步疗效，但对个性化或个体化医学的日益关注将鼓励进一步研究反应的个体预测因子或生物标志物。
