Sani Gabriele, Perugi Giulio, Tondo Leonardo
Neuroscience, Mental Health and Sensory Organ (NeSMOS) Department, Sapienza University, Rome, Italy.
Mood Disorder Lucio Bini Center, Cagliari, Rome, Italy.
Clin Drug Investig. 2017 Aug;37(8):713-727. doi: 10.1007/s40261-017-0531-2.
Lithium preparations have been successfully used to treat bipolar disorder (BD), and remain the best established long-term treatment for the disorder. In fact, lithium is a cornerstone of treatment to minimize the risk of recurrences and improve inter-episodic symptomatology. We reviewed the available evidence for the use of lithium in the treatment of BD, including its efficacy, limitations, and potential benefits also in consideration of the different formulations available. We also overviewed salient comparative aspects regarding the long-term alternative use of anticonvulsants, antidepressants, and antipsychotics in BD patients. The available evidence indicates that BD patients should be treated primarily with lithium, combined in some cases with antipsychotics especially in acute treatments, and sometimes, because of intolerance or inefficacy of lithium, with anticonvulsants. The use of adjunctive antidepressants should be limited to episodes of breakthrough depression. Lithium should be offered to the majority of BD patients as initial treatment especially when suicide ideation or behavior is present with adequate information about its long-term benefits and its potential side effects. Many patients can tolerate lithium without concomitant use of antidepressants, which may worsen the course of the illness or antipsychotics, which may cause severe long-term side effects.
锂制剂已成功用于治疗双相情感障碍（BD），并且仍然是该疾病最成熟的长期治疗方法。事实上，锂是治疗的基石，可将复发风险降至最低并改善发作间期的症状。我们回顾了使用锂治疗BD的现有证据，包括其疗效、局限性以及考虑到现有不同制剂后的潜在益处。我们还概述了BD患者长期交替使用抗惊厥药、抗抑郁药和抗精神病药的显著比较方面。现有证据表明，BD患者应以锂作为主要治疗药物，在某些情况下尤其是在急性治疗中可联合使用抗精神病药，有时由于锂不耐受或无效，可联合使用抗惊厥药。辅助性抗抑郁药的使用应限于突破性抑郁发作。对于大多数BD患者，应将锂作为初始治疗药物，尤其是在存在自杀观念或行为时，并应充分告知其长期益处和潜在副作用。许多患者可以耐受锂，而无需同时使用可能会使病情恶化的抗抑郁药或可能导致严重长期副作用的抗精神病药。
