Reginaldi D, Tondo L, Floris G, Pignatelli A, Kukopulos A
Int Pharmacopsychiatry. 1981;16(2):124-8. doi: 10.1159/000468484.
50 manic-depressive patients with rapid cycles received lithium for more than 1 year, during depression they received antidepressant drugs. Response was poor in 36, partial in 6, and good in 8. 21 of the poor responders were persuaded to endure depression without antidepressants; anxiolytics were allowed, 15 stabilized after the end of the untreated depression or after a few milder, shorter episodes; 4 improved partially; 2 were unchanged. 15 other rapid cycle patients started on lithium and stopped antidepressants at the same time. Response was good in 13, partial in 1, and poor in 1. Patients with a course of depression-hypomania (or mania)-free interval also responded poorly to prophylactic lithium when the depression was treated with antidepressants. They responded well when antidepressants were withdrawn. Antidepressants often cause or accentuate a switch from depression to hypomania or mania, and temporary refractoriness to lithium of the hypomania or mania. In this way lithium fails to prevent depression.
50例快速循环型双相情感障碍患者接受锂盐治疗超过1年，抑郁发作时服用抗抑郁药。36例疗效不佳，6例部分有效，8例疗效良好。21例疗效不佳的患者被说服在不服抗抑郁药的情况下忍受抑郁；可使用抗焦虑药，15例在未治疗的抑郁结束后或经历几次较轻微、较短的发作后病情稳定；4例部分改善；2例无变化。另外15例快速循环型患者开始服用锂盐并同时停用抗抑郁药。13例疗效良好，1例部分有效，1例疗效不佳。有抑郁-轻躁狂（或躁狂）-无发作间期病程的患者，在使用抗抑郁药治疗抑郁时，预防性使用锂盐的效果也不佳。停用抗抑郁药后他们反应良好。抗抑郁药常导致或加重从抑郁转向轻躁狂或躁狂的转变，以及轻躁狂或躁狂对锂盐的暂时难治性。这样锂盐就无法预防抑郁。
