Altshuler L L, Post R M, Leverich G S, Mikalauskas K, Rosoff A, Ackerman L
Brentwood VA Medical Center, Los Angeles, USA.
Am J Psychiatry. 1995 Aug;152(8):1130-8. doi: 10.1176/ajp.152.8.1130.
The longitudinal course of 51 patients with treatment-refractory bipolar disorder was examined to assess possible effects of heterocyclic antidepressants on occurrence of manic episodes and cycle acceleration.
Using criteria established from life charts, investigators rated the patients' episodes of mania or cycle acceleration as likely or unlikely to have been induced by antidepressant therapy. Discriminant function analyses were performed to assess predictors of vulnerability to antidepressant-induced mania or cycle acceleration. Further, the likelihood of future antidepressant-induced episodes in persons who had had one such episode was assessed.
Thirty-five percent of the patients had a manic episode rated as likely to have been antidepressant-induced. No variable was a predictor of vulnerability to antidepressant-induced mania. Cycle acceleration was likely to be associated with antidepressant treatment in 26% of the patients assessed. Younger age at first treatment was a predictor of vulnerability to antidepressant-induced cycle acceleration. Forty-six percent of patients with antidepressant-induced mania, but only 14% of those without, also showed antidepressant-induced cycle acceleration at some point in their illness.
Mania is likely to be antidepressant-induced and not attributable to the expected course of illness in one-third of treatment-refractory bipolar patients, and rapid cycling is induced in one-fourth. Antidepressant-induced mania may be a marker for increased vulnerability to antidepressant-induced cycle acceleration. Antidepressant-induced cycle acceleration (but not antidepressant-induced mania) is associated with younger age at first treatment and may be more likely to occur in women and in bipolar II patients.
对51例难治性双相情感障碍患者的病程进行研究，以评估杂环类抗抑郁药对躁狂发作及发作周期加速的可能影响。
研究人员依据生活图表制定的标准，将患者的躁狂发作或发作周期加速评定为可能或不太可能由抗抑郁治疗诱发。进行判别函数分析以评估易发生抗抑郁药诱发躁狂或发作周期加速的预测因素。此外，还评估了曾有过一次此类发作的患者未来发生抗抑郁药诱发发作的可能性。
35%的患者有被评定为可能由抗抑郁药诱发的躁狂发作。没有任何变量可作为易发生抗抑郁药诱发躁狂的预测因素。在接受评估的患者中，26%的发作周期加速可能与抗抑郁治疗有关。首次治疗时年龄较小是易发生抗抑郁药诱发发作周期加速的预测因素。46%有抗抑郁药诱发躁狂的患者，但无此情况的患者中只有14%，在病程中的某个阶段也出现了抗抑郁药诱发的发作周期加速。
在三分之一的难治性双相情感障碍患者中，躁狂可能是由抗抑郁药诱发而非疾病的预期病程所致，四分之一的患者出现发作周期加速。抗抑郁药诱发的躁狂可能是易发生抗抑郁药诱发发作周期加速的一个标志。抗抑郁药诱发的发作周期加速（而非抗抑郁药诱发的躁狂）与首次治疗时年龄较小有关，且可能更易发生于女性及双相II型患者。
