An update of evidence-based treatment of bipolar depression: where do we stand?
An update of evidence-based treatment of bipolar depression: where do we stand?
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DOI：
10.1097/yco.0b013e328333e132
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发表时间：
2010-01-01
影响因子：
6.9
通讯作者：
Fountoulakis, Konstantinos N.
中科院分区：
文献类型：
--
作者：
Fountoulakis, Konstantinos N.
目的reviewThe当前的文章试图总结我们的知识和实践在治疗双相抑郁症的现状，并提出未来的方向。最近的发现我们对锂的了解坚定地支持其在双相疾病的各个阶段的有用性和其对自杀预防的具体有效性。特定的第二代抗精神病药物可能是治疗双相抑郁症的一个有希望的选择，尽管迄今为止只有有限的数据。抗惊厥药似乎具有广泛的有效性，包括混合烦躁和快速循环形式。拉莫三嗪治疗抑郁症可能更有效，但对躁狂症无效。抗抑郁药在双相抑郁症中的作用是有争议的。双相抑郁症的第一道社会心理干预是心理教育、以家庭为中心的心理教育和认知行为治疗。电休克治疗和经颅磁刺激是难治性患者的选择。迄今为止积累的知识表明，即使在急性抑郁阶段，双相情感障碍患者也需要持续服用抗躁狂药物。总结制定合理的“联合治疗”指南在当今至关重要，因为似乎绝大多数患者在单药治疗中表现不佳，需要复杂的药物治疗。虽然我们的知识确实有限，但制定某种多药治疗指南是可能的，应该尽快完成。
Purpose of reviewThe current article attempts to summarize the current status of our knowledge and practice in the treatment of bipolar depression and suggests future directions.Recent findingsOur knowledge about lithium solidly supports its usefulness during all phases of bipolar illness and its specific effectiveness on suicidal prevention. Specific second-generation antipsychotics could constitute a promising option for treating bipolar depression, although only limited data exist so far. Anticonvulsants appear to possess a broad spectrum of effectiveness, including mixed dysphoric and rapid-cycling forms. Lamotrigine may be preferably effective in the treatment of depression but not mania. The usefulness of antidepressants in bipolar depression is controversial. The first line of psychosocial intervention in bipolar depression is psychoeducation, family-focused psychoeducation and cognitive-behavioral therapy. Electroconvulsive therapy and transcranial magnetic stimulation are options for refractory patients. Accumulated knowledge so far indicates that bipolar patients need continuous administration of an antimanic agent even during the acute depressive phase.SummaryThe development of rationalized 'combination treatment' guidelines is essential today, as it seems that the vast majority of patients do poorly on monotherapy and need complex pharmacotherapies. Although our knowledge is indeed limited, the development of some kind of guidelines for polypharmacy is possible and should be done as soon as possible.