Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry
Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry
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DOI：
10.1007/s00406-012-0323-x
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发表时间：
2012-06-01
影响因子：
4.7
通讯作者：
Vieta, Eduard
中科院分区：
文献类型：
--
作者：
Fountoulakis, Konstantinos N.;Kasper, Siegfried;Vieta, Eduard
本声明是对双相情感障碍（BP）药物治疗有效性的现有数据进行的系统性综述。以治疗选项的名称作为关键词，对有关BP治疗的MEDLINE（RCT）进行系统检索。检索于2012年3月10日更新。文献表明锂、第一代和第二代抗精神病药以及丙戊酸盐和卡马西平治疗急性躁狂症有效。奎替利和奥氮平-氟西汀联合治疗双相抑郁症也有效。抗抑郁药应仅与抗躁狂药联合使用，因为它们作为单药治疗时可诱导转换为躁狂/轻躁狂/混合状态/快速循环。锂、奥氮平、奎替鲁和阿立哌唑在维持治疗期有效。拉莫三嗪在预防抑郁症方面有效，但是否对躁狂症也有效仍有待澄清。有一些证据表明，心理社会干预作为药物治疗的替代疗法是有效的。电休克治疗是难治性患者的一种选择。对于锂/丙戊酸盐/卡马西平部分应答的急性躁狂患者，加用抗精神病药是合理的选择。在急性双相抑郁症中数据最好的组合是锂加拉莫三嗪。如果在维持治疗期间转为单药治疗，联合治疗稳定的患者可能会更糟，患者可能会受益于奥氮平、丙戊酸盐、抗抑郁药或拉莫三嗪的添加治疗，这取决于指数急性期。今天，BP的各种治疗选择都是可用的，但仍然存在巨大的未满足需求。联合治疗可以改善治疗结果，但也带来更多的副作用负担。进一步的研究是必要的，以及制定更好的指导方针和算法，逐步合理的治疗。
The current statement is a systematic review of the available data concerning the efficacy of medication treatment of bipolar disorder (BP). A systematic MEDLINE search was made concerning the treatment of BP (RCTs) with the names of treatment options as keywords. The search was updated on 10 March 2012. The literature suggests that lithium, first and second generation antipsychotics and valproate and carbamazepine are efficacious in the treatment of acute mania. Quetiapine and the olanzapine-fluoxetine combination are also efficacious for treating bipolar depression. Antidepressants should only be used in combination with an antimanic agent, because they can induce switching to mania/hypomania/mixed states/rapid cycling when utilized as monotherapy. Lithium, olanzapine, quetiapine and aripiprazole are efficacious during the maintenance phase. Lamotrigine is efficacious in the prevention of depression, and it remains to be clarified whether it is also efficacious for mania. There is some evidence on the efficacy of psychosocial interventions as an adjunctive treatment to medication. Electroconvulsive therapy is an option for refractory patients. In acute manic patients who are partial responders to lithium/valproate/carbamazepine, adding an antipsychotic is a reasonable choice. The combination with best data in acute bipolar depression is lithium plus lamotrigine. Patients stabilized on combination treatment might do worse if shifted to monotherapy during maintenance, and patients could benefit with add-on treatment with olanzapine, valproate, an antidepressant, or lamotrigine, depending on the index acute phase. A variety of treatment options for BP are available today, but still unmet needs are huge. Combination therapy may improve the treatment outcome but it also carries more side-effect burden. Further research is necessary as well as the development of better guidelines and algorithms for the step-by-step rational treatment.