Post R M, Uhde T W
Encephale. 1982;8(2):213-28.
Although opposite mood and psychomotor disturbances usually occur in mania and melancholia, clinical features may also be shared in common or may be present at the same time in both phases of manic-depressive psychosis. In a parallel fashion, most pharmacological agents are selectively effective in one mood phase (tricyclics and monoamine oxidase inhibitors for depression, and neuroleptics for mania) and frequently precipitate or exacerbate the opposite phase. These agents, therefore, may be affecting biological substrates mediating the opposing phase of affective illness. With the exception of electroconvulsive therapy and lithium chemotherapy, few treatments are effective in both mania and melancholia. It is noteworthy, therefore, that carbamazepine may be useful in the acute and prophylactic treatment of mania and melancholia, including some lithium non-responders and patients vulnerable to tricyclic-induced "mood switches". The clinical and biological effects of carbamazepine will be discussed with special emphasis on its biochemical action and the possible mechanisms by which it might influence biological substrates mediating both phases of manic-depressive illness. In addition, the theoretical implications of the presence of both shared and opposing clinical, pharmacological, and biochemical characteristics of the illness will be discussed.
虽然相反的情绪和精神运动障碍通常分别出现在躁狂症和忧郁症中，但躁郁症两个阶段的临床特征也可能有共同之处或同时出现。同样，大多数药物对一种情绪阶段有选择性疗效（三环类药物和单胺氧化酶抑制剂用于治疗抑郁症，抗精神病药物用于治疗躁狂症），并且常常会引发或加剧相反的情绪阶段。因此，这些药物可能影响了介导情感性疾病相反阶段的生物学底物。除了电休克疗法和锂盐化学疗法外，很少有治疗方法对躁狂症和忧郁症都有效。因此，值得注意的是，卡马西平可能对躁狂症和忧郁症的急性治疗及预防性治疗有用，包括一些对锂盐无反应的患者以及易受三环类药物诱发“情绪转换”影响的患者。本文将讨论卡马西平的临床和生物学效应，特别强调其生化作用以及它可能影响介导躁郁症两个阶段的生物学底物的潜在机制。此外，还将讨论该疾病临床、药理学和生化特征中既有共同之处又有相反之处这一现象的理论意义。
