University of California, Berkeley, USA.
University of California, Berkeley, USA.
J Affect Disord. 2018 Aug 15;236:136-139. doi: 10.1016/j.jad.2018.04.097. Epub 2018 Apr 22.
One previous study suggested that the presence of a manic episode before bipolar depression is related to worse response to antidepressants.
To examine this effect in a larger sample, we used data from the large, multi-site STEP-BD study. We hypothesized that among persons treated with antidepressants for bipolar depression, manic or mixed episodes before depression onset (as compared to euthymia) would predict lower rate of recovery, more sustained depressive symptoms and higher rate of switching into mania/hypomania after antidepressant treatment of bipolar depression. 320 participants were available for analyses (140 male) diagnosed with bipolar I, bipolar II, cyclothymia, bipolar disorder not otherwise specified, or schizoaffective disorder bipolar subtype. Patients were randomly assigned to 3 treatment randomization strata (placebo, bupropion, and paroxetine) as adjuncts to mood stabilizers.
Analyses were conducted to examine the effect of episode status before the depressive episode on the degree of change in depressive symptoms at 3 and 6 months, the likelihood of depression recovery and the likelihood of anti-depressant induced switching. Presence of a manic episode before depression in patients with bipolar disorder did not significantly predict response to antidepressants.
The study was limited by a high rate of attrition, and consideration of only two antidepressant medications.
Our findings are in agreement with other past studies suggesting that mania and depression may operate separately for those with bipolar disorder, with differential predictors of the onset and offset of mania versus depression. Future directions may consider vulnerability for these episodes separately.
先前有一项研究表明，双相情感障碍抑郁发作前出现躁狂发作与抗抑郁药反应较差有关。
为了在更大的样本中检验这一效应，我们使用了来自大型多中心 STEP-BD 研究的数据。我们假设，在接受抗抑郁药治疗双相情感障碍抑郁的患者中，抑郁发作前出现躁狂或混合发作（与轻躁狂相比）将预测恢复率较低、抑郁症状持续时间更长以及抗抑郁药治疗双相情感障碍抑郁后转为躁狂/轻躁狂的比例更高。共有 320 名参与者（140 名男性）可用于分析，他们被诊断为单相 I 型、单相 II 型、环性心境障碍、未特定的双相障碍或分裂情感性障碍双相型。患者被随机分配到 3 种治疗随机分组层（安慰剂、安非他酮和帕罗西汀），作为情绪稳定剂的附加治疗。
我们进行了分析，以检验抑郁发作前的发作状态对 3 个月和 6 个月时抑郁症状变化程度、抑郁恢复的可能性以及抗抑郁药引起的转换的可能性的影响。双相情感障碍患者抑郁发作前出现躁狂发作并不能显著预测抗抑郁药的反应。
该研究受到高退出率的限制，且仅考虑了两种抗抑郁药物。
我们的研究结果与其他过去的研究一致，表明躁狂和抑郁可能对双相情感障碍患者分别起作用，躁狂和抑郁的发作和消退有不同的预测因素。未来的研究方向可能需要分别考虑这些发作的易感性。
