Saiz-Ruiz J, Cebollada A, Ibañez A
Department of Psychiatry, Hospital Ramón y Cajal, Madrid, Spain.
J Psychosom Res. 1994;38 Suppl 1:55-60. doi: 10.1016/0022-3999(94)90136-8.
Ninety-six patients with bipolar disorder who attended a lithium clinic were reviewed in a retrospective study. Sleep disorders were studied in 85 depressive episodes. Eighty-one percent of the subjects presented with insomnia; the mixed type being the most frequent (49%) followed by early awakening (25%). The evolution of depression in the patients was compared according to the treatment received for insomnia: sedative antidepressants vs other anxiolytic or hypnotic drugs. Fifteen percent of patients shifted to mania, this group more frequently receiving sedative antidepressants (p < 0.05). Moreover, the patients who had received sedative antidepressants as therapy for insomnia (N = 61) showed a tendency to have a shorter asymptomatic interval before the following relapse (13 months vs 19 months; p = 0.06). In view of these results, we consider that the use of sedative antidepressants as a treatment for insomnia during depressive episodes in bipolar patients could be a factor contributing to worse prognoses; in these cases it appears that the use of other hypnotic drugs would be more advisable.
一项回顾性研究对96名在锂盐门诊就诊的双相情感障碍患者进行了评估。在85次抑郁发作中对睡眠障碍进行了研究。81%的受试者存在失眠；其中混合型最为常见（49%），其次是早醒（25%）。根据治疗失眠所采用的药物，即镇静性抗抑郁药与其他抗焦虑或催眠药物，对患者抑郁症状的演变进行了比较。15%的患者转为躁狂，该组患者更频繁地使用镇静性抗抑郁药（p<0.05）。此外，接受镇静性抗抑郁药治疗失眠的患者（N=61）在下次复发前无症状间隔期有缩短的趋势（13个月对19个月；p=0.06）。鉴于这些结果，我们认为在双相情感障碍患者抑郁发作期间使用镇静性抗抑郁药治疗失眠可能是导致预后较差的一个因素；在这些情况下，使用其他催眠药物似乎更为可取。
