Mood Disorders Psychopharmacology Unit, University Health Network , Toronto , Canada.
University Hospitals Cleveland Medical Center , Cleveland , OH , USA.
Curr Med Res Opin. 2019 Nov;35(11):1993-2005. doi: 10.1080/03007995.2019.1636017. Epub 2019 Aug 5.
We reviewed important clinical aspects of bipolar depression, a progressive psychiatric condition that is commonly treated in primary care. Bipolar depression is associated with considerable burden of illness, high suicide risk, and greater morbidity and mortality than bipolar mania. We identified articles relevant to our narrative review using a multistep search of the literature and applying terms that were relevant to bipolar depression or bipolar disorder. Bipolar depression accounts for the majority of time spent unwell for patients with bipolar disorder; high rates of morbidity and mortality arise from full symptomatic episodes and interepisode subsyndromal symptoms. Bipolar depression is an important contributor to long-term dysfunction for patients with bipolar disorder due to psychosocial impairment, loss of work productivity and high rates of substance abuse. Missed and delayed diagnosis is prevalent due to overlapping symptoms with unipolar depression and other diagnoses. Medical comorbidities (i.e. cardiovascular disease, hypertension, obesity, metabolic syndrome) and psychiatric comorbidities (i.e. anxiety disorder, personality disorder, eating disorder, attention-deficit/hyperactivity disorder) are common. Currently, only three treatments are FDA-approved for bipolar depression; monotherapy antidepressants are not a recommended treatment option. Bipolar disorder is common among primary care patients presenting with depression; it is often treated exclusively in primary care. Clinicians should be alert for symptoms of bipolar disorder in undiagnosed patients, know what symptoms probabilistically suggest bipolar versus unipolar depression, have expertise in providing ongoing treatment to diagnosed patients, and be knowledgeable about managing common medication-related side effects and comorbidities. Prompt and accurate diagnosis is critical.
我们回顾了双相情感障碍抑郁的重要临床方面，这是一种常见于初级保健的进行性精神疾病。双相情感障碍抑郁与相当大的疾病负担、高自杀风险以及比双相情感障碍躁狂更高的发病率和死亡率相关。我们使用多步骤文献搜索并应用与双相情感障碍抑郁或双相情感障碍相关的术语，确定了与我们的叙述性综述相关的文章。双相情感障碍抑郁占双相情感障碍患者患病时间的大部分；发病率和死亡率高的原因是完全症状发作和发作间亚症状。由于社会心理功能障碍、工作生产力下降和物质滥用率高，双相情感障碍抑郁是双相情感障碍患者长期功能障碍的重要原因。由于与单相抑郁和其他诊断重叠的症状，漏诊和延迟诊断很常见。常见的合并症（即心血管疾病、高血压、肥胖、代谢综合征）和合并症（即焦虑障碍、人格障碍、饮食障碍、注意力缺陷/多动障碍）。目前，只有三种治疗方法被 FDA 批准用于治疗双相情感障碍抑郁；单药抗抑郁药不是推荐的治疗选择。在出现抑郁症状的初级保健患者中，双相情感障碍很常见；它通常仅在初级保健中进行治疗。临床医生应警惕未确诊患者的双相情感障碍症状，了解哪些症状可能提示双相情感障碍而非单相抑郁，具备为确诊患者提供持续治疗的专业知识，并了解管理常见药物相关副作用和合并症的知识。及时准确的诊断至关重要。
