ANTICONVULSANTS IN LITHIUM-REFRACTORY BIPOLAR PATIENTS

使用抗惊厥药卡马西平，我们记录了急性反应 在大约三分之二的急性躁狂患者和三分之一的 严重抑郁的病人。锂强化的反应不足是 还观察到，在躁狂症和抑郁症中，尽管下降幅度更大 在T3和T4中，比单独使用任何一种药物都要好。两者的长期预防 卡马西平也记录了躁狂和抑郁的发作， 尽管有一部分患者会随着时间的推移表现出疗效的丧失。今年5月 代表着患者的耐受性的发展，似乎发生在 病情恶化最快的患者以前的病程。 对卡马西平反应不足的患者可能会对 丙戊酸盐，反之亦然。许多与不良反应相关的因素 锂盐(严重、烦躁不安、快速骑车、非家族疾病)可能 与卡马西平或丙戊酸盐的良好反应有关。因此， 卡马西平和丙戊酸盐似乎是临床上重要的选择 锂难治型双相情感障碍。没有观察到良好的反应 抗惊厥药苯妥英钠，而氯硝西潘可能是一种有用的急性 突破性躁狂发作及其相关失眠的辅助品。一个 抗惊厥钙通道阻滞剂尼莫地平的临床试验 在最初的几个项目中只有一个取得了令人满意的结果 接受治疗的病人。我们正试图阐明临床和生物学 锂与抗惊厥药物的差异反应标记物 卡马西平和丙戊酸盐。

Using the anticonvulsant carbamazepine, we have documented acute response in approximately two-thirds of acutely manic patients and one-third of acutely depressed patients. Lithium augmentation of inadequate response is also observed, in both mania and depression in spite of greater decrements in T3 and T4 than with either agent alone. Long-term prophylaxis of both manic and depressive episodes has also been documented with carbamazepine, although a subgroup of patients show loss of efficacy over time. This may represent the development of patients of tolerance and appears to occur in patients with the most rapidly deteriorating prior course of illness. Patients who are inadequately responsive to carbamazepine may respond to valproate and vice-versa. Many of the correlates of poor response to lithium (severe, dysphoric mania, rapid cycling, non-familial illness) may be associated with good response to carbamazepine or valproate. Thus, carbamazepine and valproate appear to be important clinical options in lithium-refractory bipolar illness. Good responses have not been observed to the anticonvulsant phenytoin, while clonazepam may be a useful acute adjunct for breakthrough manic episodes and their associated insomnia. A clinical trial of the anticonvulsant calcium channel blocker nimodipine has been instituted with promising results in only one of the first several patients treated. We are attempting to elucidate clinical and biological markers of differential response to lithium and the anticonvulsant agents carbamazepine and valproate.