Hernandorena Carolina, Dines Micaela, Miola Alessandro, Nuñez Nicolas A, Tondo Leonardo, Baldessarini Ross J, Vázquez Gustavo H
Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires City, Argentina.
Int J Bipolar Disord. 2025 Jul 9;13(1):24. doi: 10.1186/s40345-025-00381-y.
As choices of treatments for bipolar disorder types I (BD1) and II (BD2) and major depressive disorder (MDD) continue to evolve, we reviewed studies directly comparing current clinical usage rates of medicinal treatments for these disorders.
Comprehensive searching of five literature databases through March 2024 identified reports on clinical drug prescription rates for BD and MDD patients. Rates were summarized and compared by random-effects meta-analyses with R-Studio software.
A total of 18 reports (2006-2023) supported comparisons of clinically prescribed treatments for 17,572 mood-disorder patients (mean age 42.8 years; 7936 BD1 age 43.2 years; 6309 BD2, age 43.3; 3327 MDD, age 40.0). Among diagnoses: (BD1 vs. BD2 vs. MDD), treatments differed as: lithium (54.4% vs. 38.0% vs. 6.78%), second-generation antipsychotics (41.6% vs. 22.3% vs. 15.9%), valproate (25.7% vs. 21.5%; no MDD data), lamotrigine (13.1% vs. 27.2%; no MDD data), and antidepressants (34.9% vs. 46.4% vs. 77.5%). International use of lithium for BD appeared to increase between 2006 and 2023.
Outcomes were heterogeneous and requiring inclusion of lithium may introduce selection bias.
Clinical treatment selections for BD1, BD2, and MDD patients differed substantially. Use of modern antipsychotics is undergoing major increases for both BD and MDD; optimal use of antidepressants for BD remains uncertain; and notably, international use of lithium tended to increase in the present data.
随着双相情感障碍I型（BD1）和II型（BD2）以及重度抑郁症（MDD）治疗方案的不断演变，我们回顾了直接比较这些疾病当前药物治疗临床使用率的研究。
通过全面检索截至2024年3月的五个文献数据库，确定了关于BD和MDD患者临床药物处方率的报告。使用R-Studio软件通过随机效应荟萃分析对比率进行汇总和比较。
共有18份报告（2006 - 2023年）支持对17572名情绪障碍患者（平均年龄42.8岁；7936名BD1患者，年龄43.2岁；6309名BD2患者，年龄43.3岁；3327名MDD患者，年龄40.0岁）的临床处方治疗进行比较。在不同诊断（BD1与BD2与MDD）中，治疗方法的差异如下：锂盐（54.4%对38.0%对6.78%）、第二代抗精神病药物（41.6%对22.3%对15.9%）、丙戊酸盐（25.7%对21.5%；无MDD数据）、拉莫三嗪（13.1%对27.2%；无MDD数据）以及抗抑郁药（34.9%对46.4%对77.5%）。2006年至2023年间，国际上BD患者使用锂盐的情况似乎有所增加。
结果存在异质性，纳入锂盐可能会引入选择偏倚。
BD1、BD2和MDD患者的临床治疗选择存在显著差异。BD和MDD使用现代抗精神病药物的情况都在大幅增加；BD使用抗抑郁药的最佳方式仍不确定；值得注意的是，在当前数据中，国际上锂盐的使用呈上升趋势。
