Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Black Dog Institute, Sydney, New South Wales, Australia.
Acta Psychiatr Scand. 2024 Feb;149(2):98-109. doi: 10.1111/acps.13646. Epub 2023 Dec 10.
Treatment decision-making for individuals with bipolar disorder can be difficult. Recommendations from clinical practice guidelines can be affected by multiple methodological limitations, while pharmaco-epidemiological data suggest great variety in prescription practices across regions. Given these inconsistencies, this study aimed to provide an alternative perspective on the effectiveness of common bipolar disorder maintenance treatments through considering naturalistic data.
A total of 246 individuals with bipolar disorder (84 bipolar I [BP-I], 162 bipolar II [BP-II]) were recruited through clinics and/or websites. All were euthymic and had trialled at least one mood stabiliser. They completed an online survey containing questions on demographics, clinical variables, symptomatology, and the effectiveness/side effect profiles of any mood stabilisers (MSTs) or atypical antipsychotics (AAPs) that they have taken.
Lithium and lamotrigine were the most commonly prescribed MSTs and the most effective at mood stabilisation. Lithium and lamotrigine appeared marginally more effective for BP-I and BP-II respectively, however, only the latter difference was statistically significant. Furthermore, lamotrigine had the more favourable side effect profile. Amongst the AAPs, quetiapine and olanzapine were the most commonly prescribed, but they were negligibly superior to other AAPs.
This study clearly established a preference for lamotrigine in the maintenance treatment of BP-II. While the literature consistently emphasises the primacy of lithium in bipolar disorder treatment, its side effect profile as observed in this study remains a concern. Future research considering moderators of treatment response and concomitant medications could help to identify further nuances to consider for treatment decision-making.
对于双相情感障碍患者的治疗决策可能很困难。临床实践指南的建议可能受到多种方法学限制的影响，而药物流行病学数据表明，不同地区的处方实践存在很大差异。鉴于这些不一致性，本研究旨在通过考虑自然数据为常见双相情感障碍维持治疗的有效性提供另一种视角。
共招募了 246 名双相情感障碍患者（84 名双相 I [BP-I]，162 名双相 II [BP-II]），通过诊所和/或网站招募。所有患者均处于情绪稳定状态，且至少试用过一种情绪稳定剂。他们完成了一项在线调查，其中包含有关人口统计学、临床变量、症状和他们服用的任何情绪稳定剂 (MST) 或非典型抗精神病药物 (AAP) 的有效性/副作用特征的问题。
锂盐和拉莫三嗪是最常开的 MST，对稳定情绪最有效。锂盐和拉莫三嗪分别对 BP-I 和 BP-II 更有效，但只有后者的差异具有统计学意义。此外，拉莫三嗪的副作用特征更有利。在 AAP 中，喹硫平和奥氮平最常开处方，但它们与其他 AAP 相比几乎没有优势。
本研究清楚地确立了在 BP-II 的维持治疗中更倾向于拉莫三嗪。虽然文献一直强调锂盐在双相情感障碍治疗中的首要地位，但在本研究中观察到的其副作用特征仍然令人担忧。未来的研究考虑治疗反应的调节剂和伴随药物可以帮助确定进一步需要考虑的治疗决策的细微差别。
