Short-term fluoxetine monotherapy for bipolar type II or bipolar NOS major depression - low manic switch rate
Short-term fluoxetine monotherapy for bipolar type II or bipolar NOS major depression - low manic switch rate
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DOI：
10.1046/j.1399-5618.2003.00083.x
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发表时间：
2004-02-01
影响因子：
5.4
通讯作者：
Hundert, M
中科院分区：
文献类型：
--
作者：
Amsterdam, JD;Shults, J;Hundert, M
目的：目前双相II型（BP II）重度抑郁发作（MDE）的初始治疗指南推荐单独使用情绪稳定剂或情绪稳定剂加选择性5 -羟色胺再摄取抑制剂（SSRI）的组合。这一建议是出于对抗抑郁药引起的躁狂转换发作的担忧。然而，最近的证据表明，在SSRI治疗期间，BP II MDE的躁狂转换率可能较低。方法：作为一项随机、双盲、安慰剂对照的氟西汀单药治疗BP II MDE复发预防研究的一部分，37例患者每天接受开放标签氟西汀20mg，持续8周。结果测量包括汉密尔顿抑郁评分（HAM-D - 17）和青年躁狂症评分（YMR）量表。结果：完成8周氟西汀治疗的23例患者中有11例（48%）显示HAM-D 17降低大于或等于50%，而所有接受治疗的患者中有14例（38%）的基线HAM-D 17评分降低大于或等于50%。使用大于或等于8的保守YMR评分来识别轻度躁狂症状，氟西汀期间YMR评分大于或等于8的患者频率与筛查和基线期间的患者频率没有差异。只有3名患者（7.3%）有轻度躁狂的症状，只有1名患者因为情绪迅速转变为抑郁而停止治疗。局限性：氟西汀每日固定剂量20mg。氟西汀以开放标签的方式开处方，样本量有限。结论：这些观察结果支持了SSRI单药治疗BP II MDE期间躁狂转换率低的发现，并提示氟西汀单药治疗可能是一种安全有效的BP II MDE初始治疗方法。
Objectives: Current guidelines for the initial treatment of bipolar type II (BP II) major depressive episode (MDE) recommend using either a mood stabilizer alone or a combination of a mood stabilizer plus a selective serotonin re-uptake inhibitor (SSRI). This recommendation is the result of concern over antidepressant-induced manic switch episodes. However, recent evidence suggests that the manic switch rate may be low in BP II MDE during SSRI therapy.Methods: As part of a randomized, double-blind, placebo-controlled relapse-prevention study of fluoxetine monotherapy in BP II MDE, 37 patients received open-label fluoxetine 20 mg every day for up to 8 weeks. Outcome measures included the Hamilton Depression Rating (HAM-D 17) rating and the Young Mania Rating (YMR) scale.Results: Eleven of 23 patients (48%) who completed 8 weeks of fluoxetine treatment showed a HAM-D 17 reduction of greater than or equal to50%, while 14 (38%) of all treated patients had greater than or equal to50% reduction in baseline HAM-D 17 score. Using a conservative YMR score of greater than or equal to8 to identify hypomanic symptoms, the frequency of patients with YMR score greater than or equal to8 during fluoxetine did not differ from that seen during the screen and baseline period. Only three patients (7.3%) had symptoms suggestive of hypomania, and only one patient stopped treatment because of a rapid mood swing into depression.Limitations: Fluoxetine was given at a fixed dose of 20 mg everyday. Fluoxetine was prescribed in an open-label manner, and the sample size was limited.Conclusions: These observations support the findings of a low manic switch rate during SSRI monotherapy of BP II MDE, and suggest that fluoxetine monotherapy may be a safe and effective initial treatment of BP II MDE.