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首页> 外文期刊>The journal of clinical psychiatry >Clinical highlights in bipolar depression: focus on atypical antipsychotics.
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Clinical highlights in bipolar depression: focus on atypical antipsychotics.

机译：双相抑郁症的临床亮点：专注于非典型抗精神病药。

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Despite the considerable burden of bipolar depression, the treatment of this debilitating phase of bipolar disorder is suboptimally addressed by currently available pharmacologic options. Consequently, there is a need for the development of new treatment options with enhanced efficacy and tolerability. Evidence of antidepressant efficacy for some of the atypical antipsychotics in the treatment of bipolar depression has recently emerged. The findings of a large-scale, placebo-controlled, double-blind, randomized clinical study of olanzapine alone and in combination with fluoxetine, and a similar study of quetiapine monotherapy, suggest that some of the atypical antipsychotics may be efficacious in treating depressive symptoms in patients with bipolar I disorder. Subpopulation analyses suggest that quetiapine monotherapy and the olanzapine plus fluoxetine combination appear to be effective in treating depression in patients with a rapid-cycling course. The magnitude of improvement in depressive symptoms in the bipolar I population appears to be larger for quetiapine monotherapy compared with either olanzapine or olanzapine plus fluoxetine; however, the limitations of such a cross-study comparison are acknowledged. Both olanzapine monotherapy and combination therapy, as well as quetiapine monotherapy, were well tolerated. The overall incidence of treatment-emergent mania was low and comparable with placebo in both studies. Somnolence, weight gain, increased appetite and nonfasting glucose and cholesterol levels were more commonly reported in patients treated with olanzapine monotherapy or combination therapy compared with placebo. Dry mouth, sedation/somnolence, dizziness, and constipation were more commonly associated with quetiapine treatment. Large, controlled studies are needed to determine whether other psychotropic agents have antidepressant properties that would make them suitable for use in patients with bipolar depression. In addition, direct comparison of the regimens used in the current study should determine whether the differences evident between them can be confirmed.
机译：尽管双相情感障碍的负担相当大，但目前可用的药理学方法不能很好地解决双相情感障碍这一使人衰弱的阶段的治疗。因此，需要开发具有增强的功效和耐受性的新的治疗选择。最近出现了一些非典型抗精神病药在双相抑郁症治疗中抗抑郁功效的证据。奥氮平单独和与氟西汀联用的大规模，安慰剂对照，双盲，随机临床研究的结果以及喹硫平单药的类似研究表明，某些非典型抗精神病药可能有效治疗抑郁症状在患有双相性I型障碍的患者中。亚群分析表明，喹硫平单药治疗和奥氮平加氟西汀联合治疗似乎可以有效治疗快速循环患者的抑郁症。与奥氮平或奥氮平加氟西汀相比，喹硫平单药治疗双相I人群抑郁症状的改善幅度似乎更大。但是，这种跨研究比较的局限性得到了承认。奥氮平单一疗法和联合疗法以及喹硫平单一疗法均具有良好的耐受性。两项研究中，治疗紧急性躁狂的总体发生率较低，与安慰剂相当。与安慰剂相比，奥氮平单一疗法或联合疗法治疗的患者更常报告嗜睡，体重增加，食欲增加以及空腹血糖和胆固醇水平升高。口腔干燥，镇静/嗜睡，头晕和便秘通常与喹硫平治疗有关。需要进行大规模的对照研究，以确定其他精神药物是否具有抗抑郁药的特性，使其适合用于双相抑郁症患者。此外，对当前研究中使用的方案进行直接比较应确定是否可以确认它们之间明显的差异。

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