Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA.
J Affect Disord. 2014 Dec;169 Suppl 1:S34-44. doi: 10.1016/S0165-0327(14)70007-2.
The most commonly used pharmacologic therapies for bipolar depression are mood stabilizers, atypical antipsychotics, and antidepressants. This paper reviews common side effects associated with these medications and provides recommendations for managing adverse medication effects in clinical practice.
Narrative review based on literature searches of Medline and evidence-based treatment guidelines for agents that have been approved by the US Food and Drug Administration and/or are commonly used to treat bipolar depression.
Side effects of bipolar depression pharmacotherapies are common and vary by medication, with weight gain, metabolic dysregulation, sedation/somnolence, and akathisia among those observed most frequently. These adverse events (weight gain and sedation/somnolence, in particular) negatively affect treatment adherence in patients with bipolar disorder. Furthermore, endocrine and metabolic comorbidities, weight gain, and obesity may reduce the likelihood of positive clinical responses to pharmacologic therapies. Clinicians may consider switching patients to bipolar depression medication(s) with a lower propensity for sedation or adverse metabolic effects. Lifestyle modification (e.g., dietary changes, exercise) is an important component in the treatment of weight gain/obesity, dyslipidemia, hypertension, and hyperglycemia; in addition, a wide range of medications are available as therapeutic options for patients in whom non-pharmacologic management strategies are insufficient. The use of adjunctive medication may also reduce treatment-related sedation and somnolence.
The selection of relevant studies from the literature search relied primarily on the author's expertise in the area of bipolar depression and knowledge of the issues addressed.
Successful treatment of bipolar depression extends beyond managing mood symptoms to also monitoring adverse medication events and managing associated medical disorders.
双相情感障碍抑郁的最常用药物治疗方法是心境稳定剂、非典型抗精神病药和抗抑郁药。本文综述了这些药物相关的常见副作用，并就如何在临床实践中管理不良反应提供建议。
基于文献检索的叙述性综述，检索了 Medline 和美国食品药品监督管理局批准的或常用于治疗双相情感障碍抑郁的药物的循证治疗指南。
双相情感障碍药物治疗的副作用很常见，且因药物而异，最常观察到的是体重增加、代谢紊乱、镇静/嗜睡和静坐不能。这些不良事件（尤其是体重增加和镇静/嗜睡）会降低双相障碍患者的治疗依从性。此外，内分泌和代谢合并症、体重增加和肥胖可能会降低药物治疗的临床反应可能性。临床医生可能会考虑将患者转换为镇静作用或代谢不良影响较小的双相情感障碍药物。生活方式的改变（如饮食改变、运动）是治疗体重增加/肥胖、血脂异常、高血压和高血糖的重要组成部分；此外，还有广泛的药物可供治疗非药物管理策略不足的患者。辅助药物的使用也可能会减少治疗相关的镇静和嗜睡。
从文献检索中选择相关研究主要依赖于作者在双相情感障碍领域的专业知识以及对所解决问题的了解。
成功治疗双相情感障碍不仅要控制情绪症状，还要监测药物不良反应并管理相关的躯体疾病。
