Are antidepressants safe in the treatment of bipolar depression? A critical evaluation of their potential risk to induce switch into mania or cycle acceleration
Are antidepressants safe in the treatment of bipolar depression? A critical evaluation of their potential risk to induce switch into mania or cycle acceleration
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DOI：
10.1111/j.1600-0447.2008.01237.x
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发表时间：
2008-11-01
影响因子：
6.7
通讯作者：
Angst, J.
中科院分区：
文献类型：
--
作者：
Licht, R. W.;Gijsman, H.;Angst, J.
目的：为了解决是否开关抑郁症轻躁狂或躁狂或周期加速双相情感障碍患者是由抗抑郁药或这种现象是否是由于双相情感障碍本身的自然史。方法：一个重要的文献回顾，指出在来源的偏见，以前被忽视。研究的因果关系的问题，Bradford-Hill标准，即特异性的潜在致病剂，效果的强度，结果的一致性，剂量-反应关系，时间与暴露于代理前effects. Results的时间关系和生物accessibility.Results：有一个稀缺的随机研究解决这个问题，现有的研究都遭受各种形式的偏见。然而，有一些证据表明，除了情绪稳定剂的抗抑郁药是不相关的增加率的开关相比，与情绪稳定剂单独。结论：当与情绪稳定剂相结合，抗抑郁药给予急性双相抑郁症似乎不会引起轻躁狂或躁狂症的开关。抗抑郁药是否可能加速双相情感障碍患者的发作频率和/或可能导致其他形式的不稳定仍有待适当研究。
Objective: To address whether switch of depression into hypomania or mania or cycle acceleration in patients with bipolar disorder is caused by antidepressants or whether this phenomenon is attributable to the natural history of bipolar disorder itself.Method: A critical review of the literature, pointing at sources of bias that have been previously overlooked. For examining the causation in question, the Bradford-Hill criteria were applied, i.e. specificity of the potential causative agent, strength of effect, consistency in findings, dose-response relation, temporal relation with exposure to agent preceding effect and biological plausibility.Results: There is a scarcity of randomized studies addressing the question, and the available studies all suffer from various forms of bias. However, there is some evidence suggesting that antidepressants given in addition to a mood stabilizer are not associated with an increased rate of switch when compared with the rate associated with the mood stabilizer alone.Conclusion: When combined with a mood stabilizer, antidepressants given for acute bipolar depression seemingly do not induce a switch into hypomania or mania. Whether antidepressants may accelerate episode frequency and/or may cause other forms of destabilization in patients with bipolar disorder remain to be properly studied.