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首页> 外文期刊>The journal of clinical psychiatry >Reevaluating therapies for bipolar depression.
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Reevaluating therapies for bipolar depression.

机译：重新评估双相抑郁症的治疗方法。

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The most commonly employed pharmacotherapies for bipolar depression include antidepressants, lithium, and anticonvulsants, such as lamotrigine, valproate, and carbamazepine. A combination of these agents, usually an antidepressant and a mood stabilizer, is often required to achieve an optimal response. However, some treatment guidelines still caution that antidepressant exposure should be minimized in patients with bipolar depression, due to concern that they may trigger treatment-emergent mania or cycle acceleration. This advice prevails despite data showing that antidepressants are effective in treating bipolar depression and evidence that coadministration of a mood-stabilizing medication, at least with modern antidepressants, such as the selective serotonin reuptake inhibitors, can reduce the risk of treatment-emergent mania to levels comparable with those observed with mood stabilizer monotherapy. Although the antidepressant efficacy of most mood stabilizers has not been satisfactorily proven, first-line therapy with 1 mood stabilizer alone or a combination of 2 mood stabilizers is still recommended by many guidelines. Inappropriate treatment of bipolar depression may leave patients at high risk of suicide and increased chronicity of symptoms; effective therapy should, therefore, be provided as early as possible. The efficacy and safety of antidepressants for bipolar depression both as monotherapy and when combined with a mood stabilizer should be studied in adequately powered trials in order to revise treatment guidelines. Electroconvulsive therapy remains an option for treatment-refractory patients and those intolerant to pharmacologic treatment, as well as patients who are pregnant or at high risk of suicide.
机译：用于双相抑郁的最常用药物疗法包括抗抑郁药，锂和抗惊厥药，例如拉莫三嗪，丙戊酸盐和卡马西平。通常需要将这些药物（通常是抗抑郁药和情绪稳定剂）结合使用以达到最佳效果。然而，一些治疗指南仍然警告，由于担心双相抑郁症患者可能触发治疗性躁狂或周期加速，因此应将抗抑郁药的暴露降至最低。尽管有数据显示抗抑郁药可有效治疗躁郁症，并且有证据表明至少与现代抗抑郁药（例如选择性5-羟色胺再摄取抑制剂）共同使用稳定情绪的药物，可将出现治疗性躁狂症的风险降低至一定水平，但该建议仍然有效与使用情绪稳定剂单一疗法观察到的结果相当。尽管大多数情绪稳定剂的抗抑郁功效尚未得到令人满意的证明，但许多指南仍建议仅使用一种情绪稳定剂或将两种情绪稳定剂组合使用的一线治疗。躁郁症的不当治疗可能使患者处于自杀的高风险中，并增加症状的长期性;因此，应尽早提供有效的治疗。无论是单药治疗还是与情绪稳定剂联用，抗抑郁药对双相抑郁的疗效和安全性都应在足够有力的试验中进行研究，以修订治疗指南。对于治疗难治性患者和不耐受药物治疗的患者，以及怀孕或自杀风险高的患者，电抽搐治疗仍然是一种选择。

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