Antosik-Wójcińska Anna Zofia, Stefanowski Bogdan, Święcicki Łukasz
Oddział Chorób Afektywnych IPiN w Warszawie.
Psychiatr Pol. 2015;49(6):1223-39. doi: 10.12740/PP/37914.
The use of antidepressants in treatment of depression in course of bipolar disorders (BD) is controversial. In case of no improvement during monotherapy with mood stabilizer, the use of antidepressants is often necessary. The safety of this group (in context of phase change, mixed states and rapid cycling) is essential and is the subject of many research. In the paper, the authors review the literature concerning efficacy and safety of use of antidepressants in the treatment of affective disorders and long-term impact on the course of the disease. Selection of articles have been made by searching the Medline and Pubmed databases using keywords: antidepressant drugs, bipolar depression, bipolar disorder, efficacy, safety, mania, hypomania. The risk of mania is greater in bipolar disorder type I, than in type II or during treatment with Tricyclic antidepressants (TCAs) and treatment with venlafaxine. The use of SSRIs and bupropion is associated with a relatively small increase of phase change risk. There are different opinions concerning recommended duration of antidepressant treatment. Generally antidepressant use should end after 2-3 months of remission, the risk of recurrence of depression after discontinuation of antidepressants is, however, higher than in case of continuation. In BD type II or BD spectrum, antidepressant monotherapy is allowed in severe depression. In bipolar disorder type I and in case of phase change after antidepressants use in the past, use of antidepressants should be very cautious. Antidepressants are contraindicated in rapid cycling and in mixed episodes. Further work is needed to evaluate the efficacy and safety of antidepressants use.
在双相情感障碍（BD）病程中使用抗抑郁药治疗抑郁症存在争议。在使用心境稳定剂单药治疗无效的情况下，通常需要使用抗抑郁药。该类药物的安全性（在病情转变、混合状态和快速循环的背景下）至关重要，是许多研究的主题。在本文中，作者回顾了有关抗抑郁药治疗情感障碍的疗效和安全性以及对疾病病程长期影响的文献。通过使用关键词“抗抑郁药、双相抑郁、双相情感障碍、疗效、安全性、躁狂、轻躁狂”在Medline和Pubmed数据库中检索来选择文章。I型双相情感障碍中躁狂发作的风险高于II型双相情感障碍，或高于三环类抗抑郁药（TCA）治疗及文拉法辛治疗期间。使用选择性5-羟色胺再摄取抑制剂（SSRI）和安非他酮与病情转变风险的相对小幅增加相关。关于抗抑郁药治疗的推荐疗程存在不同观点。一般来说，抗抑郁药应在病情缓解2 - 3个月后停用，然而，停用抗抑郁药后抑郁症复发的风险高于继续用药的情况。在II型双相情感障碍或双相情感障碍谱系中，严重抑郁症时允许使用抗抑郁药单药治疗。在I型双相情感障碍以及过去使用抗抑郁药后出现病情转变的情况下，使用抗抑郁药应非常谨慎。快速循环和混合发作时禁用抗抑郁药。需要进一步开展工作来评估使用抗抑郁药的疗效和安全性。
