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首页> 外文期刊>The journal of clinical psychiatry >The use of antidepressants in bipolar disorder.
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The use of antidepressants in bipolar disorder.

机译：在双相情感障碍中使用抗抑郁药。

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BACKGROUND: Whether or not to use antidepressants in patients with bipolar disorder is a matter of debate. Antidepressant treatment of bipolar depression has been associated with manic switch and cycle acceleration. Furthermore, recent studies have argued against the efficacy of antidepressants in the treatment of bipolar depression. Nevertheless, many clinicians continue to employ antidepressants, especially in the management of severe depression that is unresponsive to mood stabilizers alone. OBJECTIVE: Because of the unclear risk-to-benefit ratio of antidepressants in bipolar disorder, we have performed an updated review of the relevant literature. In this article we examine (1) all randomized controlled trials (RCTs) evaluating the use of antidepressants in the treatment of acute bipolar depression and assessing the risk of antidepressant-induced manic switch and (2) non-RCT trials that evaluate the impact of antidepressant discontinuation after acute antidepressant response. DATA SOURCES: A MEDLINE search of journals, covering the period from January 1966 to July 2007 and supplemented by bibliographic cross-referencing, was performed to identify the relevant studies. The keywords used were antidepressant, bipolar depression, bipolar disorder, switch, manic switch, antidepressant-induced mania, predictors, and antidepressant discontinuation. Criteria used to select studies included (1) English language and (2) studies published in peer-reviewed journals. DATA SYNTHESIS: Randomized, double-blind, placebo-controlled studies have demonstrated that antidepressants exert some efficacy in the treatment of bipolar depression in some populations of patients. Moreover, the risk of manic switch, although not totally countered, appears to be strongly reduced when antidepressants are given in combination with a mood stabilizer and when new-generation antide-pressants are preferred over old tricyclic antidepressants. Finally, some studies have proven that the continuous use of antidepressants after the remission of a major depressive episode helps to prevent further depressive relapses without causing a significant increase in manic relapses. CONCLUSIONS: Clearly, there is a place for antidepressants in bipolar disorder; however, it is important to be cautious and evaluate their use on a case-by-case basis. Looking at specific depressive symptoms might help physicians in making the choice of whether to prescribe or not prescribe antidepressants.
机译：背景：双相情感障碍患者是否使用抗抑郁药尚存在争议。双相抑郁的抗抑郁治疗与躁狂转换和周期加速有关。此外，最近的研究反对抗抑郁药在治疗躁郁症中的功效。尽管如此，许多临床医生仍在继续使用抗抑郁药，尤其是在对仅对情绪稳定剂无反应的严重抑郁症的治疗中。目的：由于双相情感障碍中抗抑郁药的风险收益比尚不清楚，因此我们对相关文献进行了更新回顾。在本文中，我们研究（1）所有评估抗抑郁药在治疗急性双相抑郁中的使用和评估抗抑郁药引起的躁狂转换的风险的随机对照试验（RCT），以及（2）评估抗抑郁药引起的躁狂切换的风险的非随机对照试验。急性抗抑郁反应后停用抗抑郁药。数据来源：对MEDLINE涵盖1966年1月至2007年7月的期刊进行检索，并辅以书目交叉引用，以查明相关研究。使用的关键词是抗抑郁药，双相抑郁症，双相情感障碍，开关，躁狂开关，抗抑郁药诱发的躁狂症，预测指标和抗抑郁药停用。用于选择研究的标准包括（1）英语和（2）在同行评审期刊上发表的研究。数据综合：随机，双盲，安慰剂对照研究表明，抗抑郁药在某些患者的双相抑郁症治疗中具有一定疗效。而且，当抗抑郁药与情绪稳定剂联合使用时，并且当新一代抗抑郁药优于旧的三环抗抑郁药时，躁狂转换的风险虽然不能完全抵消，但似乎可以大大降低。最后，一些研究证明，重度抑郁发作缓解后继续使用抗抑郁药有助于预防进一步的抑郁症复发，而不会导致躁狂症复发显着增加。结论：显然，双相情感障碍中有抗抑郁药的地方。但是，请务必谨慎并逐案评估其使用。查看特定的抑郁症状可能有助于医生选择是否开抗抑郁药。

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