Xiao Naomi, Yin Liyang, Lee Serene, Teopiz Kayla M, Wong Sabrina, Le Gia Han, Badulescu Sebastian, Lo Heidi Ka Ying, Vinberg Maj, Cao Bing, Grande Iria, Rosenblat Joshua D, McIntyre Roger S
Brain and Cognition Discovery Foundation, Toronto, Canada.
Department of Health Sciences, Queen's University, Kingston, Canada.
Bipolar Disord. 2025 Aug;27(5):347-357. doi: 10.1111/bdi.70049. Epub 2025 Aug 13.
There is a need to provide up-to-date, clinically translatable data as it relates to the treatment of a major depressive episode (MDE) with mixed features.
PubMed and OVID were searched from inception to July 22, 2024. Randomized controlled trials (RCTs) investigating the efficacy of pharmacological agents for adults with bipolar disorder (BD) or major depressive disorder (MDD) in an MDE with mixed features were included. Risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomized Studies (RoB2).
A total of seven studies were included in this systematic review. The studies identified were all short-term acute studies ranging from 6 to 8 weeks. Treatment with lurasidone, olanzapine, cariprazine, lumateperone, quetiapine, and ziprasidone was associated with statistically significant reduction of depressive symptoms in MDEs with mixed features. Only lumateperone is studied in both BD subtypes [bipolar I disorder (BD-I), bipolar II disorder (BD-II)] and MDD, wherein efficacy in mixed features was the prespecified primary outcome. Lurasidone has a single study in MDD, while ziprasidone has data in a mixed sample of BD-II and MDD. Data for the other agents in mixed features is post hoc. Co-occurring hypomanic symptoms generally improved, and there was no significant difference between the above treatments and placebo with respect to hypomanic symptom severity intensification or treatment-emergent affective switching.
Select atypical antipsychotics are effective in alleviating depressive symptoms in persons with mixed features; albeit, much of the data is obtained from post hoc analysis. Minimal evidence exists for the efficacy of lithium or valproate in the treatment of depressive episodes with mixed features. Antidepressant monotherapy has not been adequately evaluated in depressive episodes with mixed features. In addition, there is a pressing need for a consistent definition of mixed presentations to guide future interventional studies.
有必要提供与伴有混合特征的重度抑郁发作（MDE）治疗相关的最新临床可转化数据。
检索了自数据库建立至2024年7月22日的PubMed和OVID。纳入了调查药物制剂对伴有混合特征的重度抑郁发作的双相情感障碍（BD）或重度抑郁症（MDD）成人患者疗效的随机对照试验（RCT）。使用Cochrane随机研究偏倚风险工具（RoB2）评估偏倚风险。
本系统评价共纳入7项研究。所纳入的研究均为6至8周的短期急性研究。使用鲁拉西酮、奥氮平、卡立普多、鲁马西酮、喹硫平和齐拉西酮治疗与伴有混合特征的MDE中抑郁症状的统计学显著减轻相关。仅鲁马西酮在双相情感障碍的两种亚型[双相I型障碍（BD-I）、双相II型障碍（BD-II）]和MDD中进行了研究，其中混合特征中的疗效是预先设定的主要结局。鲁拉西酮在MDD中有一项研究，而齐拉西酮在BD-II和MDD的混合样本中有数据。其他药物在混合特征方面的数据是事后分析得出。同时出现的轻躁狂症状总体有所改善，上述治疗与安慰剂在轻躁狂症状严重程度加重或治疗中出现的情感转换方面无显著差异。
某些非典型抗精神病药物在减轻伴有混合特征患者的抑郁症状方面有效；尽管如此，大部分数据来自事后分析。关于锂盐或丙戊酸盐治疗伴有混合特征的抑郁发作疗效的证据极少。抗抑郁药单药治疗在伴有混合特征的抑郁发作中尚未得到充分评估。此外，迫切需要对混合表现进行一致的定义，以指导未来的干预研究。
