Yalin Nefize, Young Allan H
Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Neuropsychiatr Dis Treat. 2020 Jun 9;16:1459-1472. doi: 10.2147/NDT.S245166. eCollection 2020.
Depression accounts for the predominant burden associated with bipolar disorder. The identification and management of bipolar depression are challenging, since bipolar depression differs from unipolar depression, responding poorly to traditional antidepressants, which may also induce a switch to hypomania/mania, mixed states and/or cause rapid cycling. Current treatment options for bipolar depression are limited and guidelines vary greatly in their recommendations, reflecting gaps and inconsistencies in the current evidence base. Moreover, some treatment options, such as quetiapine and olanzapine-fluoxetine, although clearly efficacious, may be associated with adverse cardiometabolic side effects, which can be detrimental to the long-term physical health and well-being of patients, increasing the likelihood of treatment non-adherence and relapse. Evidence for some more recent therapeutic options, including lurasidone and cariprazine, suggests that patients' symptoms can be effectively managed without compromising their physical health. In addition, novel agents targeting alternative neurotransmitter pathways and inflammatory processes (such as ketamine and N-acetyl cysteine) are emerging as promising potential options for the treatment of bipolar depression in the future.
抑郁症是双相情感障碍相关的主要负担。双相抑郁的识别与管理颇具挑战，因为双相抑郁与单相抑郁不同，对传统抗抑郁药反应不佳，传统抗抑郁药还可能诱发转相至轻躁狂/躁狂、混合状态和/或导致快速循环发作。目前双相抑郁的治疗选择有限，且指南在推荐方面差异很大，这反映出当前证据基础存在差距和不一致性。此外，一些治疗选择，如喹硫平和奥氮平-氟西汀，虽然疗效明确，但可能会伴有不良的心脏代谢副作用，这可能对患者的长期身体健康和幸福感有害，增加治疗不依从和复发的可能性。一些更新的治疗选择，包括鲁拉西酮和卡立普嗪的证据表明，在不损害患者身体健康的情况下，可以有效控制患者症状。此外，针对其他神经递质途径和炎症过程的新型药物（如氯胺酮和N-乙酰半胱氨酸）正成为未来治疗双相抑郁的有前景的潜在选择。
