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双相障碍相关抗抑郁药诱发的躁狂症:潜在临床和遗传风险因素的综述和荟萃分析。

Antidepressant-Associated Mania in Bipolar Disorder: A Review and Meta-analysis of Potential Clinical and Genetic Risk Factors.

出版信息

J Clin Psychopharmacol. 2020 Mar/Apr;40(2):180-185. doi: 10.1097/JCP.0000000000001186.

DOI:10.1097/JCP.0000000000001186
PMID:32134853
Abstract

PURPOSES/BACKGROUND: Antidepressants (ADs) play a valuable role in treating the depressive episodes of bipolar disorder. However, 14% of these individuals taking ADs experience AD-associated mania (AAM) within a few weeks of starting treatment. Numerous studies have suggested potential clinical and genetic risk factors. We aimed to conduct a comprehensive systematic review and meta-analysis that integrates the past literature with the recent studies and identifies important predictors for AAM.

METHODS/PROCEDURES: The review was limited to experimentally designed studies that contain the relevant search terms in PubMed and PsychInfo. After removing studies that were in discordance with our criteria, the review included 24 reports examining clinical risk factors and 10 investigating genetic risk factors. Our meta-analysis was conducted on 5 clinical risk factors, each of which had at least 4 articles with extractable data.

FINDINGS/RESULTS: The only clinical factors in the literature that have been shown to be more indicative of AAM risk are AD monotherapy and tricyclic ADs. Among genetic factors, the serotonin transporter gene polymorphism may play a minor role in AAM. Our meta-analysis provided support for the number of prior depressive episodes.

IMPLICATIONS/CONCLUSION: Prevention of AAM may be served by early detection of recurrent depression episodes. Further large-scale longitudinal studies are required to determine the underpinnings of AAM.

摘要

目的/背景:抗抑郁药(ADs)在治疗双相情感障碍的抑郁发作中发挥了重要作用。然而,这些服用 ADs 的人中,有 14%的人在开始治疗的几周内出现 AD 相关躁狂(AAM)。许多研究提出了潜在的临床和遗传风险因素。我们旨在进行一项全面的系统综述和荟萃分析,该分析将过去的文献与最近的研究相结合,确定 AAM 的重要预测因素。

方法/程序:本综述仅限于设计实验的研究,这些研究在 PubMed 和 PsychInfo 中包含相关的搜索词。在排除与我们的标准不一致的研究后,本综述包括了 24 项研究,这些研究分别考察了临床风险因素和 10 项研究了遗传风险因素。我们对 5 个临床风险因素进行了荟萃分析,每个因素都有至少 4 篇具有可提取数据的文章。

结果/发现:文献中唯一被证明与 AAM 风险更相关的临床因素是 AD 单药治疗和三环类 ADs。在遗传因素中,5-羟色胺转运体基因多态性可能在 AAM 中发挥较小的作用。我们的荟萃分析支持既往抑郁发作次数较多的观点。

结论

早期发现复发性抑郁发作可能有助于预防 AAM。需要进一步的大规模纵向研究来确定 AAM 的潜在基础。

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