Boerlin H L, Gitlin M J, Zoellner L A, Hammen C L
Department of Psychiatry, University of California, Los Angeles School of Medicine, UCLA Neuropsychiatric Institute and Hospital, USA.
J Clin Psychiatry. 1998 Jul;59(7):374-9. doi: 10.4088/jcp.v59n0706.
The likelihood and character of antidepressant-induced mania remain important but poorly understood factors in the treatment of bipolar depression.
We examined the response to naturalistic treatment of 29 bipolar I patients who experienced a total of 79 depressive episodes. Treatment consisted primarily of mood stabilizers used alone (N = 31) or in combination with antidepressants (N = 48). Intensity of baseline mood stabilizer therapy, adequacy of added antidepressant therapy, intensity of ensuing mania or hypomania, and course of illness prior to study were measured, and selected comparisons were made between treatment groups.
Postdepressive mood elevations (i.e., switches) that occurred during or up to 2 months after each depressive episode were present in 28% (22/79) and judged to be severely disruptive in only 10% (8/79) of episodes. Examining only the first episode per patient, a history of a greater number of past manic episodes was associated with a higher risk of switching (p < .023). Antidepressant treatment combined with mood stabilizer therapy was not associated with higher rates of postdepressive mood elevation than mood stabilizer therapy alone. At a descriptive level, subjects treated with tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) were associated with a higher switch rate than those treated with fluoxetine; TCAs were also associated with more intense switches.
The frequency and severity of postdepressive mood elevation associated with acute or continuation antidepressant therapy may be reduced by mood stabilizers. Such elevations may be more likely in patients with a strong history of mania.
在双相抑郁症的治疗中，抗抑郁药诱发躁狂的可能性及特征仍是重要但了解甚少的因素。
我们研究了29例双相I型患者对自然疗法的反应，这些患者共经历了79次抑郁发作。治疗主要包括单独使用心境稳定剂（N = 31）或与抗抑郁药联合使用（N = 48）。测量了基线心境稳定剂治疗的强度、加用抗抑郁药治疗的充分性、随后出现的躁狂或轻躁狂的强度以及研究前的病程，并在治疗组之间进行了选定的比较。
每次抑郁发作期间或发作后2个月内出现的抑郁后情绪高涨（即转换）发生率为28%（22/79），且仅10%（8/79）的发作被判定为严重干扰。仅检查每位患者的首次发作，既往躁狂发作次数较多的病史与转换风险较高相关（p < 0.023）。与单独使用心境稳定剂治疗相比，抗抑郁药治疗联合心境稳定剂治疗与抑郁后情绪高涨的发生率较高无关。在描述性层面，接受三环类抗抑郁药（TCA）和单胺氧化酶抑制剂（MAOI）治疗的受试者比接受氟西汀治疗的受试者转换率更高；TCA还与更强烈的转换相关。
心境稳定剂可能降低与急性或持续抗抑郁药治疗相关的抑郁后情绪高涨的频率和严重程度。在有强烈躁狂病史的患者中，这种情绪高涨可能更易发生。
