Hui Poon Shi, Sim Kang, Baldessarini Ross J
Department of General Psychiatry, Institute of Mental Health, 10, Buangkok View, Singapore 539747.
Curr Neuropharmacol. 2015;13(5):592-604. doi: 10.2174/1570159x13666150630171954.
Bipolar disorder is prevalent, with high risks of disability, substance abuse and premature mortality. Treatment responses typically are incomplete, especially for depressive components, so that many cases can be considered "treatment resistant." We reviewed reports on experimental treatments for such patients: there is a striking paucity of such research, mainly involving small incompletely controlled trials of add-on treatment, and findings remain preliminary. Encouraging results have been reported by adding aripiprazole, bupropion, clozapine, ketamine, memantine, pramipexole, pregabalin, and perhaps tri-iodothyronine in resistant manic or depressive phases. The urgency of incomplete responses in such a severe illness underscores the need for more systematic, simpler, and better controlled studies in more homogeneous samples of patients.
双相情感障碍很常见，存在高致残风险、药物滥用风险和过早死亡风险。治疗反应通常不彻底，尤其是对抑郁症状而言，因此许多病例可被视为“难治性”。我们回顾了针对此类患者的实验性治疗报告：此类研究明显匮乏，主要涉及小型的、控制不完整的附加治疗试验，且研究结果仍属初步。在难治性躁狂或抑郁阶段，加用阿立哌唑、安非他酮、氯氮平、氯胺酮、美金刚、普拉克索、普瑞巴林，或许还有三碘甲状腺原氨酸，已报告有令人鼓舞的结果。在如此严重的疾病中，治疗反应不彻底的紧迫性凸显了在更同质化的患者样本中开展更系统、更简单且控制更好的研究的必要性。
