Post R M, Ketter T A, Pazzaglia P J, George M S, Marangell L, Denicoff K
Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892.
Neuropsychobiology. 1993;27(3):132-7. doi: 10.1159/000118968.
There is increasing recognition that lithium is inadequate in the treatment of up to 50% of bipolar patients. In addition to subgroups that are nonresponsive from the outset, loss of efficacy (tolerance) and discontinuation-induced refractoriness have recently been observed. The anticonvulsants carbamazepine and valproate are effective alternative or adjunctive treatments, but tolerance can also occur during their long-term prophylactic use. New treatment algorithms for this loss of efficacy, including combination therapies, require further systematic study. Preliminary data suggesting that some patients with extremely rapid and chaotic mood fluctuations may respond to the L-type calcium channel blocker nimodipine are presented, and the theoretical implications discussed.
越来越多的人认识到，锂盐对高达50%的双相情感障碍患者治疗效果不佳。除了一开始就无反应的亚组患者外，最近还观察到疗效丧失（耐受性）和停药引起的难治性。抗惊厥药卡马西平和丙戊酸盐是有效的替代或辅助治疗药物，但在长期预防性使用过程中也可能出现耐受性。针对这种疗效丧失的新治疗方案，包括联合治疗，需要进一步的系统研究。本文展示了初步数据，表明一些情绪波动极快且紊乱的患者可能对L型钙通道阻滞剂尼莫地平有反应，并讨论了其理论意义。
