Departamento de Psiquiatria e Medicina Legal, Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ) , Rio de Janeiro , Brazil.
Departamento de Especialidades Médicas, Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro (FCM/UERJ) , Rio de Janeiro , Brazil.
Expert Opin Drug Saf. 2019 Oct;18(10):893-913. doi: 10.1080/14740338.2019.1651291. Epub 2019 Aug 8.
: The use of antidepressants (AD) in the treatment of bipolar depression is one of the most controversial issues in psychopharmacology. For some, AD are useful, but, for others, they should never be used in bipolar depression. : This review examines published clinical studies on the use of ADs in bipolar depression, addressing their clinical efficacy and the occurrence of side effects, manic switches, cycle acceleration, and suicidal behavior. Meta-analyzes and review articles on the subject are also discussed. : Approved therapeutic options for bipolar depression are associated with not very high response rates and a high incidence of adverse effects. Patients with bipolar depression present very heterogeneous responses to the use of ADs. Some improve significantly, while others, especially those with concomitant manic symptoms, have had previous episodes of treatment-emergent mania or are rapid cyclers, exhibit manic switches or cycle acceleration. The authors conclude that the real question is not whether ADs should or should not be used in bipolar depression, but which patients benefit from these drugs and which ones are impaired. The concept of bipolar spectrum and a dimensional approach on bipolar/unipolar distinction may be useful for understanding the heterogeneity of responses to ADs.
在双相情感障碍的治疗中使用抗抑郁药（AD）是精神药理学中最具争议的问题之一。对于一些人来说，AD 是有用的，但对于另一些人来说，它们在双相情感障碍中不应该使用。
这篇综述审查了关于 AD 在双相情感障碍中的使用的已发表的临床研究，探讨了它们的临床疗效和副作用、躁狂转换、周期加速和自杀行为的发生。还讨论了关于该主题的荟萃分析和综述文章。
双相情感障碍的批准治疗选择与不太高的反应率和高不良反应发生率相关。双相情感障碍患者对 AD 的使用反应非常不同。一些患者显著改善，而另一些患者，特别是那些伴有躁狂症状的患者，以前曾出现过治疗引起的躁狂发作，或快速循环者，出现躁狂转换或周期加速。作者得出结论，真正的问题不是 AD 是否应该或不应该在双相情感障碍中使用，而是哪些患者从这些药物中受益，哪些患者受损。双相谱的概念和双相/单相区分的维度方法可能有助于理解对 AD 的反应的异质性。
