Antidepressants: The scapegoat of poor outcome bipolar disorder?
Antidepressants: The scapegoat of poor outcome bipolar disorder?
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抗抑郁药：双相情感障碍不良结局的替罪羊？
DOI：
10.1177/0004867412441103
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发表时间：
2012
影响因子：
4.6
通讯作者：
J. Goldberg
中科院分区：
文献类型：
--
作者：
J. Goldberg
澳大利亚和新西兰精神病学杂志，46（4）像精神病学中的许多结构一样，治疗双相情感障碍的抗抑郁药已经成为分裂的对象，在许多从业者眼中，它们要么是“全好”要么是“全坏”。20世纪60年代和70年代的早期病例报告指出，一些抑郁症患者在开始使用三环类抗抑郁药（TCA）或单胺氧化酶抑制剂（MAOI）后不久可能会出现躁狂或轻躁狂症状。20世纪80年代，这些观察结果又促使研究人员提出了一个有趣的假设，即抗抑郁药可能会将一些抑郁症患者从抑郁症迅速推向躁狂或轻躁狂，超过正常心境;从长远来看，它们可能会增加随后两种极性发作的频率。尽管很少有系统的，前瞻性的研究来评估这一假设，该领域似乎一夜之间接受了这一命题作为教条。当代的指南要么完全避免使用抗抑郁药治疗双相抑郁症，要么勉强承认它们是一种必要的邪恶，条件是抗躁狂药物先于抗抑郁药物暴露，以尽量减少不稳定的风险。关于双相抑郁症中抗抑郁药引起的情绪不稳定，我们实际上知道些什么？也许首先，所谓的问题的范围似乎远不如人们想象的那么大。在迄今为止规模最大的抗抑郁药相关躁狂/轻躁狂荟萃分析中，Tondo及其同事（2010）在109项抗抑郁药试验中纳入了114，521名双相情感障碍受试者，发现抗抑郁药诱导的躁狂或轻躁狂的总体发生率仅为12.5%;值得注意的是，与抗躁狂药物联合治疗并没有明显降低总体风险。与其想象抗抑郁药会不分青红皂白地对任何和所有抑郁双相患者的情绪状态造成严重破坏，不如将情绪不稳定视为一种相对罕见的现象，在可定义的高风险亚组中发生的易感性更高。可能有助于识别这些高脆弱性患者的特征包括：
Australian & New Zealand Journal of Psychiatry, 46(4) Like so many constructs within psychiatry, antidepressants in the treatment of bipolar disorder have become the object of a split that renders them as being either ‘all good’ or ‘all bad’ in the eyes of many practitioners. Early case reports in the 1960s and 1970s noted that some depressed patients may develop manic or hypomanic symptoms soon after beginning a tricyclic antidepressant (TCA) or monoamine oxidase inhibitor (MAOI). Those observations in turn led investigators in the 1980s to pose the intriguing hypothesis that antidepressants might acutely nudge some depressed patients from depression into mania or hypomania, overshooting euthymia; longer term, they may increase the frequency of subsequent episodes of either polarity. Despite minimal systematic, prospective research to evaluate this hypothesis, the field seemingly overnight embraced this proposition as dogma. Contemporary guidelines either altogether shun the use of antidepressants for bipolar depression or else grudgingly acknowledge their role as a necessary evil, with the proviso that antimanic drugs precede antidepressant exposure to minimize the risk of destabilization. What is actually known about mood destabilization from antidepressants in bipolar depression? Perhaps first and foremost, the scope of the alleged problem appears far less than one might think. In the largest metaanalysis of antidepressant-associated mania/hypomania to date, encompassing 114,521 bipolar subjects across 109 antidepressant trials, Tondo and colleagues (2010) found the overall incidence of antidepressant-induced mania or hypomania to be only 12.5%; remarkably, co-therapy with antimanic drugs did not appreciably lower overall risk. Rather than imagine antidepressants to wreak havoc on mood states indiscriminately for any and all depressed bipolar patients, it appears more realistic to consider mood destabilization as a relatively rare phenomenon that occurs with greater susceptibility in a definable high-risk subgroup. Characteristics that may help to identify such higher-vulnerability patients include:
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DOI：
10.1176/appi.ajp.2009.09020284
发表时间：
2010-07
期刊：
The American journal of psychiatry
影响因子：
--
作者：
Amsterdam JD;Shults J
通讯作者：
Shults J
影响因子：
4.8
作者：
Henry, C;Mitropoulou, V;Siever, LJ
通讯作者：
Siever, LJ
影响因子：
5.3
作者：
Altshuler, Lori L.;Post, Robert M.;Suppes, Trisha
通讯作者：
Suppes, Trisha
影响因子：
158.5
作者：
Sachs, Gary S.;Nierenberg, Andrew A.;Thase, Michael E.
通讯作者：
Thase, Michael E.