Szmulewicz A G, Angriman F, Samamé C, Ferraris A, Vigo D, Strejilevich S A
Hospital de Emergencias Psiquiátricas Torcuato de Alvear, Buenos Aires, Argentina.
Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina.
Acta Psychiatr Scand. 2017 Jun;135(6):527-538. doi: 10.1111/acps.12712. Epub 2017 Mar 3.
To systematically examine the effects of dopaminergic agents (modafinil, armodafinil, pramipexole, methylphenidate, and amphetamines) on bipolar depression outcomes.
Meta-analysis of randomized controlled trials was performed to assess the efficacy and safety of treatment with dopaminergic agents in bipolar depression. In a secondary analysis, findings from both randomized controlled trials and high-quality observational studies were pooled by means of meta-analytic procedures to explore dopaminergic treatment-related new mania.
Nine studies (1716 patients) were included in our meta-analysis of randomized controlled trials. Treatment with dopaminergic agents for bipolar depression was associated with an increase in both response (1671 individuals, RR 1.25, 95% CI 1.05 to 1.50) and remission rates (1671 individuals, RR 1.40, 95% CI 1.14, 1.71). There was no evidence of an increased risk of mood switch associated with this treatment (1646 individuals, RR 0.96, 95% CI 0.49, 1.89). Our secondary analysis (1231 individuals) yielded a cumulative incidence of mood switch of 3% (95% CI 1.0, 5.0) during a mean follow-up period of 7.5 months.
Preliminary findings suggest that dopaminergic agents may represent a useful alternative for the treatment of bipolar depression, with no evidence for a related increase in the risk of mood destabilization during short-term follow-up.
系统研究多巴胺能药物（莫达非尼、阿戈美拉汀、普拉克索、哌甲酯和苯丙胺）对双相抑郁结局的影响。
进行随机对照试验的荟萃分析，以评估多巴胺能药物治疗双相抑郁的疗效和安全性。在二次分析中，通过荟萃分析程序汇总随机对照试验和高质量观察性研究的结果，以探讨多巴胺能治疗相关的新发性躁狂。
我们对随机对照试验的荟萃分析纳入了9项研究（1716例患者）。多巴胺能药物治疗双相抑郁与反应率（1671例个体，RR 1.25，95%CI 1.05至1.50）和缓解率（1671例个体，RR 1.40，95%CI 1.14，1.71）的增加相关。没有证据表明这种治疗会增加情绪转换的风险（1646例个体，RR 0.96，95%CI 0.49，1.89）。我们的二次分析（1231例个体）显示，在平均7.5个月的随访期内，情绪转换的累积发生率为3%（95%CI 1.0，5.0）。
初步研究结果表明，多巴胺能药物可能是治疗双相抑郁的一种有用替代方法，且在短期随访中没有证据表明会增加情绪不稳定的风险。
