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首页> 外文期刊>The journal of clinical psychiatry >Rationale for using lithium in combination with other mood stabilizers in the management of bipolar disorder.
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Rationale for using lithium in combination with other mood stabilizers in the management of bipolar disorder.

机译：在双相情感障碍的治疗中与其他情绪稳定剂联合使用锂的基本原理。

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Bipolar disorder is a complex illness, and no single agent has been proven in randomized, placebo-controlled trials to effectively prevent and/or control all aspects of the illness-acute mania, rapid cycling, and breakthrough depression. However, for the most important issue, prophylaxis of episodes, lithium has more evidence of efficacy than any other agent. Like lithium, typical antipsychotics, carbamazepine, divalproex, and the atypical antipsychotic olanzapine are effective in the treatment of mania. Carbamazepine, divalproex, and olanzapine seem effective in preventing manic episodes but, like lithium, are less effective in preventing depression. Few trials have been conducted in the more difficult-to-treat characteristics of bipolar disorder, specifically, rapid cycling and break-through depression. For patients with rapid cycling, carbamazepine or divalproex therapy may improve symptoms, but only lamotrigine has been shown to reduce cycling, mostly in the bipolar II group, in a randomized, placebo-controlled study. For the treatment of depressive episodes, lithium and olanzapine have shown modest efficacy in controlled trials, and among the mood stabilizers, lamotrigine has the most robust effect. Because manic symptoms may respond best to one agent and depressive symptoms to another, combination therapy may be the optimal treatment for many patients with bipolar disorder. For example, lithium augmentation may improve overall response rates to treatment with carbamazepine or divalproex, and the lithium-lamotrigine combination should provide effective prevention of both mania and depression. Also, each mood stabilizer may be given at lower doses when given in combination, resulting in a reduced side effect burden and improved compliance.
机译：躁郁症是一种复杂的疾病，在随机，安慰剂对照试验中，没有一种药物能有效预防和/或控制疾病的急性躁狂症，快速循环和突破性抑郁症的各个方面。但是，对于最重要的问题（预防发作），锂比其他任何药物都有更多的功效证据。像锂一样，典型的抗精神病药，卡马西平，divalproex和非典型的抗精神病药奥氮平可有效治疗躁狂症。卡马西平，双丙戊酸钠和奥氮平似乎对预防躁狂发作有效，但与锂一样，对预防抑郁的疗效较差。对于双相情感障碍更难治疗的特征，尤其是快速循环和突破性抑郁症，尚未进行过任何试验。对于快速骑自行车的患者，卡马西平或divalproex治疗可能会改善症状，但在一项随机，安慰剂对照研究中，仅拉莫三嗪已被证明可减少骑自行车，主要是在双相II组。对于抑郁症发作，锂和奥氮平在对照试验中显示适度的疗效，在情绪稳定剂中，拉莫三嗪的作用最强。由于躁狂症状可能对一种药物产生最佳反应，而抑郁症状对另一种药物产生反应，因此联合疗法可能是许多双相情感障碍患者的最佳治疗方法。例如，增加锂可以提高对卡马西平或双丙戊酸钠治疗的总体反应率，锂-拉莫三嗪的组合应可有效预防躁狂症和抑郁症。而且，当组合使用时，可以以较低的剂量给予每种情绪稳定剂，从而降低了副作用负担并改善了依从性。

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