Long-term naturalistic follow-up of lithium augmentation: Relevance to bipolarity
Long-term naturalistic follow-up of lithium augmentation: Relevance to bipolarity
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DOI：
10.1016/j.jad.2010.08.022
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发表时间：
2011-03-01
影响因子：
6.6
通讯作者：
Koyama, Tsukasa
中科院分区：
文献类型：
--
作者：
Inoue, Takeshi;Abekawa, Tomohiro;Koyama, Tsukasa
背景：双相情感障碍（未被识别的双相情感障碍）是否与抗抑郁药难治性抑郁症中锂盐增强治疗的反应有关仍不清楚。我们在 1995 年至 1997 年间对 29 名抗抑郁药难治性重性抑郁患者进行了研究，这项研究对锂盐增补治疗有反应和无反应，根据长期随访后的诊断确认，比较了随访时的双相诊断。方法：在被分类为 2 期难治性抑郁症之前，这些患者已接受过至少两种三环类或杂环类药物的充分治疗。 不同药理学类别的抗抑郁药（至少相当于 150 毫克丙咪嗪，持续 4 周）。 1995-1997 年间，29 名患者接受了锂强化治疗。他们的治疗反应被记录下来。平均随访时间为 8.0 年（范围：1-13 年）。评估双相转变和完全缓解。结果：长期随访后，4 名锂盐反应者中有 3 名诊断为双相抑郁，25 名锂盐无反应者中有 3 名诊断为双相抑郁；锂强化治疗对于未被识别的双相情感障碍患者更有效。只有双相情感障碍家族史才能预测随后的双相情感转变。 局限性：在这项样本量较小的自然主义研究中，治疗并未受到控制。 结论： 这项长期随访研究的结果表明，双相情感障碍与 2 期难治性重度抑郁症患者对锂盐强化治疗的积极反应有关。双相情感障碍家族史提示假性单相抑郁症，因此表明对锂有反应。 (C) 2010 Elsevier B.V. 保留所有权利。
Background: Whether bipolarity (unrecognized bipolar disorder) is related to the treatment response to lithium augmentation in antidepressant-refractory depression remains unclear. This study of responders and non-responders to lithium augmentation of 29 antidepressant-refractory patients with major depression, whom we had studied during 1995-1997, compared the bipolar diagnosis at the follow-up based on diagnostic confirmation after long-term follow-up.Methods: Before being classified as stage 2 treatment-resistant depression, these patients had been treated adequately with at least two tricyclic or heterocyclic antidepressants from different pharmacological classes (a minimum of the equivalent of 150 mg of imipramine for 4 weeks). During 1995-1997, 29 patients received lithium augmentation. Their treatment responses were recorded. Mean follow-up was 8.0 years (range, 1-13 years). Bipolar conversion and full remission were evaluated.Results: After the long-term follow-up, diagnoses were changed to bipolar depression in 3 of 4 lithium responders and 3 of 25 lithium non-responders; lithium augmentation was more effective for unrecognized bipolar patients. Only the family history of bipolar disorder predicted subsequent bipolar conversion.Limitations: Treatment was not controlled in this naturalistic study, which had a small sample size.Conclusions: Results of this long-term follow-up study suggest that bipolarity is related to a positive response to lithium augmentation in stage 2 treatment-resistant major depression. The family history of bipolar disorder suggests false unipolar depression, and therefore indicates lithium responders. (C) 2010 Elsevier B.V. All rights reserved.