Strawbridge Rebecca, Yalin Nefize, Orfanos Stelios, Young Allan H
Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
South London & Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK.
Brain Sci. 2023 Jan 13;13(1):140. doi: 10.3390/brainsci13010140.
Acetazolamide, a carbonic anhydrase inhibitor, is used to treat a variety of ailments. It has been highlighted for its potential to benefit people with bipolar disorders, for whom there are clear current unmet treatment needs. This scoping review sought to synthesise all available evidence related to the potential effects of acetazolamide on symptoms related to bipolar disorder, acceptability and tolerability, and intervention characteristics (e.g., dose and duration). Following publication of the review protocol, the Pubmed, Embase, and PsycInfo databases were searched (all dated to 31 August 2022). A systematic approach was undertaken to identify eligible articles and extract relevant data from these. Five studies were included, assessing a total of 50 patients treated with acetazolamide. Most patients were from two open-label trials, while the others were case reports. Approximately one third of patients were experiencing psychosis or mania before treatment initiation, and one third had refractory depression. Forty-four percent of patients were estimated to achieve a response (not seemingly affected by the baseline episode type, acetazolamide dose, or duration), while a further 22% appeared to experience minimal benefits from the intervention. Acetazolamide was generally reported to be tolerated well and acceptable for up to 2 years, although reporting for acceptability and tolerability was suboptimal. The reviewed evidence is extremely limited in size and methodology (e.g., no randomised studies, blinding, or standardised outcome assessment). We posit that the current findings are sufficiently encouraging to recommend substantive clinical trials, but we emphasise that at present, the evidence is exceedingly preliminary, and there remains evident uncertainty as to whether acetazolamide could be a viable treatment for bipolar disorders.
乙酰唑胺是一种碳酸酐酶抑制剂，用于治疗多种疾病。它因其对双相情感障碍患者可能有益而受到关注，目前双相情感障碍患者存在明显未满足的治疗需求。本范围综述旨在综合所有与乙酰唑胺对双相情感障碍相关症状的潜在影响、可接受性和耐受性以及干预特征（如剂量和持续时间）有关的现有证据。在综述方案发表后，检索了PubMed、Embase和PsycInfo数据库（所有数据截至2022年8月31日）。采用系统方法识别符合条件的文章并从中提取相关数据。纳入了五项研究，共评估了50例接受乙酰唑胺治疗的患者。大多数患者来自两项开放标签试验，其他为病例报告。约三分之一的患者在开始治疗前患有精神病或躁狂症，三分之一患有难治性抑郁症。估计44%的患者有反应（似乎不受基线发作类型、乙酰唑胺剂量或持续时间的影响），另有22%的患者似乎从干预中获益甚微。一般报告称，乙酰唑胺耐受性良好，在长达2年的时间内均可接受，尽管关于可接受性和耐受性的报告并不理想。所审查的证据在规模和方法上极其有限（例如，没有随机研究、盲法或标准化结局评估）。我们认为目前的研究结果足以令人鼓舞，值得推荐进行实质性的临床试验，但我们强调，目前证据极为初步，乙酰唑胺是否可能成为双相情感障碍的可行治疗方法仍存在明显不确定性。
