New concepts in mood stabilization: Evidence for the effectiveness of valproate and lamotrigine
New concepts in mood stabilization: Evidence for the effectiveness of valproate and lamotrigine
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DOI：
10.1016/s0893-133x(98)00025-6
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发表时间：
1998-09-01
影响因子：
7.6
通讯作者：
Bowden, CL
中科院分区：
文献类型：
--
作者：
Bowden, CL
认识到锂对双相情感障碍的总体益处有限，而对于更严重的疾病形式则有更大的缺点，这激发了人们对替代疗法的兴趣。丙戊酸的用途证据发展历史悠久，最终形成了精心设计的安慰剂对照研究，这些研究证实了双丙戊酸形式的丙戊酸在急性躁狂症中的功效。研究总体上是积极的，但尚未得出结论，表明双相情感障碍的预防性治疗持续有益。丙戊酸的功效范围比锂更广泛，适用于患有某些更严重疾病的患者；例如，混合躁狂症。治疗前血浆 GABA 活性与双丙戊酸钠改善躁狂症状的程度呈正相关。锂和丙戊酸盐具有可比临床益处的证据刺激了研究，表明锂和丙戊酸盐对特定 G 蛋白相关信号转导有重叠作用，但卡马西平则不然。其他抗癫痫药物可能对双相情感障碍有效的可能性鼓励了对几种新型抗癫痫药物的早期临床研究。已提出其中一种拉莫三嗪 Ins 功效的初步证据。 (C) 1998 年美国神经精神药理学学院。由爱思唯尔科学公司出版
Recognition of limited overall benefits from lithium in bipolar disorder, with even greater disadvantages in more severe forms of the disease, has spurred interest in alternative therapies. A long history of development of evidence for the utility of valproate has culminated in well-designed, placebo-controlled studies that establish the efficacy of the divalproex form of valproate in acute mania. Generally positive, but as yet not conclusive, studies indicate continued benefits in prophylactic treatment of bipolar disorder. The spectrum of efficacy of valproate is somewhat broader than that of lithium, extending to patients with certain more severe forms of the illness; e.g., mixed manics. Pretreatment plasma GABA activity was positively correlated with magnitude of improvement in manic symptomatology with divalproex. The evidence of comparable clinical benefits for lithium and valproate has stimulated studies that indicate overlapping effects on specific G protein-linked signal transduction for lithium and valproate, but not for carbamazepine. The possibility that additional antiepileptic drugs might have efficacy in bipolar disorder has encouraged early clinical studies with several newer antiepileptic drugs. Preliminary evidence for the efficacy of one of these, lamotrigine, Ins been presented. (C) 1998 American College of Neuropsychopharmacology. Published by Elsevier Science Inc.