Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA.
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Psychiatry Res. 2022 May;311:114468. doi: 10.1016/j.psychres.2022.114468. Epub 2022 Feb 22.
The depressive phase of bipolar disorder causes significant functional impairment and disease burden. The efficacy and safety of antidepressants in the treatment of bipolar depression has long been a subject of debate.
To synthesize evidence of the effectiveness, risk of mood switching, and tolerability of adjunctive antidepressants in acute bipolar depression compared to using mood stabilizers or antipsychotics alone.
Multiple databases were searched for randomized controlled trials, including open label and double-blinded, for patients ages 18 or older with acute bipolar depression, comparing efficacy and adverse events in those who used adjunctive antidepressants versus without. Risk of bias and outcomes were assessed using the Cochrane Risk of Bias Tool. This study has PROSPERO registration CRD42016037701.
Nineteen studies met inclusion criteria. Adjunctive antidepressants showed no significant effect on improving response rate (RR=1.10, 95%CI: 0.98-1.23). Subgroup analysis showed that adjunctive antidepressants with antipsychotics had a small but significantly better response rate compared to antipsychotics alone, which was not seen with adjunctive antidepressants with mood stabilizers. However, that finding was limited by studies predominantly using olanzapine as the antipsychotic medication. Adjunctive antidepressants had no clinically significant impact (but a small statistically significant impact) on improving depressive symptoms (SMD=-0.13, 95%CI: -0.24 to -0.02). There was no association with increased mood switch (RR=0.97, 95%CI: 0.68-1.39) and there was an association with lower dropout due to inefficacy (RR=0.66, 95%CI: 0.45∼0.98).
There is no evidence of adjunctive antidepressants clinically improving response rate or depressive symptoms for acute bipolar depression. They are well tolerated, without increasing the risk of short-term mood switch.
双相情感障碍的抑郁期会导致显著的功能障碍和疾病负担。抗抑郁药治疗双相情感障碍抑郁的疗效和安全性一直是争论的焦点。
综合评估辅助使用抗抑郁药与单独使用心境稳定剂或抗精神病药治疗急性双相抑郁的疗效、情绪转换风险和耐受性。
检索多个数据库，包括开放标签和双盲，纳入年龄 18 岁及以上的急性双相抑郁患者，比较使用辅助抗抑郁药与未使用辅助抗抑郁药的患者的疗效和不良反应。使用 Cochrane 偏倚风险工具评估偏倚风险和结局。本研究已在 PROSPERO 注册，注册号为 CRD42016037701。
纳入了 19 项研究。辅助抗抑郁药对提高反应率没有显著效果（RR=1.10，95%CI：0.98-1.23）。亚组分析显示，与单独使用抗精神病药相比，辅助抗抑郁药联合抗精神病药的反应率略有提高，但与辅助抗抑郁药联合心境稳定剂相比，反应率没有提高。然而，这一发现受到研究中主要使用奥氮平作为抗精神病药物的限制。辅助抗抑郁药对改善抑郁症状（SMD=-0.13，95%CI：-0.24 至 -0.02）没有显著的临床影响（但有统计学上的显著影响）。辅助抗抑郁药与情绪转换增加无关（RR=0.97，95%CI：0.68-1.39），但与因疗效不佳而退出率降低有关（RR=0.66，95%CI：0.45-0.98）。
目前没有证据表明辅助抗抑郁药在治疗急性双相抑郁时能改善反应率或抑郁症状。它们耐受性良好，不会增加短期情绪转换的风险。
