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 也观察到，尽管T3和T4的下降幅度比任何一个都要大 只有探员一个人。长期的预防措施也被记录在案 卡马西平，尽管有一小部分患者在 时间到了。这可能代表了耐受性的发展，并似乎发生了 在先前病程恶化最快的患者中。 对卡马西平反应不足的患者可能会对 丙戊酸盐，反之亦然。因此，卡马西平和丙戊酸盐似乎是 治疗难治性双相情感障碍的重要临床选择。好的 对抗惊厥药物苯妥英没有观察到反应，而 氯硝西潘可能对突破性躁狂发作和他们的 伴发性失眠。抗惊厥钙通道的临床试验 阻滞剂尼莫地平已经问世。我们正试图辨别克林尼- CAL和生物学标记物对锂离子的差异反应 不同的抗惊厥剂。

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.