Keck P E, McElroy S L, Strakowski S M
Department of Psychiatry, University of Cincinnati College of Medicine, Ohio 45267-0559, USA.
J Clin Psychiatry. 1998;59 Suppl 6:74-81; discussion 82.
A number of recent advances in clinical psychopharmacology regarding anticonvulsant and new antipsychotic medications have important implications with respect to the treatment of patients who have bipolar disorder. The authors reviewed the available literature on the efficacy of the anticonvulsants valproate, carbamazepine, gabapentin, and lamotrigine for the treatment of bipolar disorder. They also reviewed the use of standard and new antipsychotic medications for the treatment of various aspects of the illness. Valproate and carbamazepine have been shown to be effective in the treatment of acute mania in controlled trials. Preliminary data suggest that these agents may differ in their time course of antimanic activity and predictors of response. Neither agent has been extensively studied in controlled trials in bipolar depression or as maintenance therapy, although carbamazepine has received the most systematic study in these areas. Gabapentin and lamotrigine are only now being evaluated in controlled trials in patients who have bipolar disorder. Antipsychotics are commonly used in the treatment of patients with acute mania and as maintenance treatment. However, the use of standard antipsychotics in acute mania is associated with a number of limitations. New antipsychotic agents may possess thymoleptic as well as antipsychotic activity, but they have not been studied in controlled trials in bipolar disorder.
临床精神药理学在抗惊厥药和新型抗精神病药物方面的一些最新进展，对于双相情感障碍患者的治疗具有重要意义。作者回顾了关于丙戊酸盐、卡马西平、加巴喷丁和拉莫三嗪等抗惊厥药治疗双相情感障碍疗效的现有文献。他们还回顾了标准和新型抗精神病药物在治疗该疾病各个方面的应用情况。在对照试验中，丙戊酸盐和卡马西平已被证明对治疗急性躁狂有效。初步数据表明，这些药物在抗躁狂活性的时间进程和反应预测因素方面可能存在差异。尽管卡马西平在这些领域得到了最系统的研究，但这两种药物在双相抑郁的对照试验或作为维持治疗方面都没有得到广泛研究。加巴喷丁和拉莫三嗪目前才在双相情感障碍患者的对照试验中进行评估。抗精神病药物常用于治疗急性躁狂患者和作为维持治疗。然而，在急性躁狂中使用标准抗精神病药物存在一些局限性。新型抗精神病药物可能具有心境稳定以及抗精神病活性，但它们尚未在双相情感障碍的对照试验中进行研究。
