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，在躁狂症和抑郁症，尽管更大的递减 在T3和T4中，与单独使用任何一种药物相比。 两者的长期预防 躁狂和抑郁发作也被记录为使用卡马西平， 尽管一个亚组的患者随着时间的推移显示出功效的丧失。这可能 代表患者耐受性的发展，似乎发生在 既往病程恶化最快的患者。 对卡马西平反应不充分的患者， 丙戊酸盐，反之亦然。 许多相关的不良反应， 锂（严重，烦躁躁狂，快速循环，非家族性疾病）可能 与卡马西平或丙戊酸盐的良好反应相关。 因此，在本发明中， 卡马西平和丙戊酸盐似乎是重要的临床选择 锂难治性双相情感障碍 尚未观察到良好的反应 抗惊厥药苯妥英钠，而氯硝西泮可能是一个有用的急性 辅助突破性躁狂发作及其相关的失眠。 一 抗惊厥钙通道阻滞剂尼莫地平的临床试验 在最初的几个国家中， 患者治疗。 我们试图从临床和生物学角度 对锂和抗惊厥药的不同反应标志物 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.