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症患者和三分之一的 严重抑郁的病人反应不足的锂强化是 也观察到，尽管T3和T4的下降幅度大于 特工独自一人长期预防也有记录， 卡马西平，虽然一个亚组的患者显示失去疗效超过 时间这可能代表耐受性的发展， 在既往病程恶化最快的患者中。 对卡马西平反应不充分的患者， 丙戊酸盐，反之亦然。因此，卡马西平和丙戊酸盐似乎 难治性双相情感障碍的重要临床选择。好 尚未观察到对抗惊厥药苯妥英的反应， 氯硝西泮可能对突破性躁狂发作及其 相关失眠症抗惊厥钙通道的临床试验 已开始使用阻滞剂尼莫地平。我们试图辨别临床- 钙和生物标志物的差异反应锂和 不同的抗惊厥药

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 spite of greater decrements in T3 and T4 than with either agent alone. Long-term prophylaxis has also been documented with carbamazepine, although a subgroup of patients show loss of efficacy over time. This may represent the development 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. Thus, carbamazepine and valproate appear to be important clinical options in treatment-refractory bipolar illness. Good responses have not been observed to the anticonvulsant phenytoin, while clonazepam may be useful for breakthrough manic episodes and their associated insomnia. A clinical trial of the anticonvulsant calcium channel blocker nimodipine has been instituted. We are attempting to discern clini- cal and biological markers of differential response to lithium and different anticonvulsant agents.