Rovera C, Esposito C M, Ciappolino V, Cattaneo D, Baldelli S, Clementi E, Altamura A C, Buoli M
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
Clinical Pharmacology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.
Drug Saf Case Rep. 2017 Oct 23;4(1):13. doi: 10.1007/s40800-017-0057-9.
International guidelines consider quetiapine at medium doses (300-400 mg/day) as valid options for the treatment of bipolar depression for the supposed lower risk of a switch to hypomania/mania than antidepressants. Norquetiapine is an active metabolite with antidepressant action. We describe three cases of induced hypomania in bipolar type 2 subjects who received quetiapine extended-release monotherapy (300 mg/day) for a mild/moderate major depressive episode. Quetiapine and norquetiapine plasma concentrations were measured after 1 week of treatment. Hypomania appeared after 7-10 days of quetiapine extended-release monotherapy and all subjects had a quetiapine/norquetiapine plasma concentration ratio <1. We propose a ratio value <1 as a predictor of risk for a switch to hypomania in bipolar depressed subjects receiving quetiapine extended-release monotherapy. Future research should ascertain the validity of this laboratory parameter to assess the risk of quetiapine-induced hypomania in large samples of bipolar patients.
国际指南认为，中等剂量（300 - 400毫克/天）的喹硫平是治疗双相抑郁的有效选择，因为与抗抑郁药相比，其转换为轻躁狂/躁狂的风险较低。去甲喹硫平是一种具有抗抑郁作用的活性代谢产物。我们描述了3例双相2型患者在接受喹硫平缓释单药治疗（300毫克/天）以治疗轻度/中度重度抑郁发作时诱发轻躁狂的病例。治疗1周后测定了喹硫平和去甲喹硫平的血浆浓度。喹硫平缓释单药治疗7 - 10天后出现轻躁狂，所有患者的喹硫平/去甲喹硫平血浆浓度比值<1。我们提出<1的比值可作为接受喹硫平缓释单药治疗的双相抑郁患者转换为轻躁狂风险的预测指标。未来的研究应确定该实验室参数在评估大量双相情感障碍患者中喹硫平诱发轻躁狂风险方面的有效性。
