Bipolar depression: a new, role for atypical antipsychotics?
Bipolar depression: a new, role for atypical antipsychotics?
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DOI：
10.1111/j.1399-5618.2005.00213.x
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发表时间：
2005-01-01
影响因子：
5.4
通讯作者：
Keck, PE
中科院分区：
文献类型：
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作者：
Keck, PE
双相抑郁症是双相情感障碍最常见的阶段，导致显著的发病率和死亡率。传统药物如锂、拉莫三嗪或抗抑郁药均提供一些临床疗效;然而，疗效可能有限，副作用有时也是问题。因此，对于用于治疗双相抑郁症的有效的、耐受性良好的药剂存在主要未满足的需求。非典型抗精神病药物，其证明对躁狂症状的疗效，正在成为候选人用于对抑郁阶段的双相情感障碍。一些研究表明，一些药物可以改善双相情感障碍患者混合发作的抑郁症状;然而，很少有研究专门针对双相抑郁发作的患者进行。在一项针对急性双相I型抑郁患者的随机、安慰剂对照试验中，与安慰剂相比，奥氮平单药治疗和奥氮平-氟西汀联合治疗显著改善了蒙哥马利-艾斯伯格抑郁量表（MADRS）总分（p <0.001），相应的效应量（活性治疗相对于安慰剂的改善除以合并标准差）分别为0.32和0.68。重要的是，三组之间转换为躁狂的比率没有显著差异。最近在双相I型和11型双相抑郁发作患者中进行的一项为期8周的随机安慰剂对照试验结果显示，与安慰剂相比，奎替鲁肽（300和600 mg/天）在改善抑郁症的核心症状（包括自杀念头）方面具有显著更大的疗效。与安慰剂相比，奎替鲁肽显著改善了MADRS总评分（p <0.001）;观察到300和600 mg/天奎替鲁肽的效应量（奎替鲁肽相对于安慰剂的改善除以合并标准差）分别为0.66和0.80。两种剂量的奎替鲁肽都显著改善了焦虑症状、睡眠质量和整体生活质量（所有，与安慰剂相比p <0.001）。这些初步研究结果表明，非典型抗精神病药物可能被证明是未来双相抑郁症患者的重要治疗方法。
Bipolar depression, the most common phase of bipolar disorder, causes significant morbidity and mortality. Traditional drugs such as lithium, lamotrigine or antidepressants each offer some clinical efficacy; however, efficacy can be limited and side effects are sometimes problematic. Thus there is a major unmet need for effective, well-tolerated agents for the treatment of bipolar depression. The atypical antipsychotics, with their proven efficacy against manic symptoms, are emerging as candidates for use against the depressive phase of bipolar disorder. Several studies have shown that some atypicals improve depressive symptoms in mixed episodes in patients with bipolar disorder; however, few studies have been performed in patients specifically with bipolar depressive episodes. In a randomized, placebo-controlled trial in patients with acute bipolar I depression, olanzapine monotherapy and an olanzapine-fluoxetine combination significantly improved Montgomery-Asberg Depression Rating Scale (MADRS) total scores compared with placebo (p < 0.001) with corresponding effect sizes (improvement of active treatment over placebo divided by pooled standard deviation) of 0.32 and 0.68, respectively. Importantly, there were no significant differences in rates of switch into mania among the three groups. Recent results from an 8-week, randomized placebo-controlled trial in patients with bipolar I and 11 disorder who were experiencing a bipolar depressive episode showed that quetiapine (300 and 600 mg/day) had significantly greater efficacy compared with placebo in improving the core symptoms of depression, including suicidal thoughts. Quetiapine significantly improved MADRS total scores compared with placebo (p < 0.001); effect sizes (improvement of quetiapine over placebo divided by pooled standard deviation) of 0.66 and 0.80 for 300 and 600 mg/day quetiapine, respectively, were observed. Both doses of quetiapine significantly improved symptoms of anxiety, sleep quality and global quality of life (all, p < 0.001 versus placebo). These initial findings suggest that atypical antipsychotics may prove to be important future treatments for patients with bipolar depression.