原文：
The 2002 American Psychiatric Association (APA) guidelines for the treatment of bipolar disorder recommended more conservative use of antidepressants. This change in comparison with previous APA guidelines has been criticized, especially from some groups in Europe. The Munich group in particular has published a critique of assumptions underlying the conservative recommendations of the recent APA treatment guidelines. In this paper, we re-examine the argument put forward by the Munich group, and we demonstrate that indeed, conceptually and empirically, there is a strong rationale for a cautious approach to antidepressant use in bipolar disorder, consistent with, and perhaps even more strongly than, the APA guidelines. This rationale is based on support for the following four propositions: (i) The risk of antidepressant induced mood-cycling is high, (ii) Antidepressants have not been shown to definitively prevent completed suicides and reduce mortality, whereas lithium has, (iii) Antidepressants have not been shown to be more effective than mood stabilizers in acute bipolar depression and have been shown to be less effective than mood stabilizers in preventing depressive relapse in bipolar disorder and (iv) Mood stabilizers, especially lithium and lamotrigine, have been shown to be effective in acute and prophylactic treatment of bipolar depressive episodes. We therefore draw three conclusions from this interpretation of the evidence: (i) There are significant risks of mania and long-term worsening of bipolar illness with antidepressants, (ii) Antidepressants should generally be reserved for severe cases of acute bipolar depression and not routinely used in mild to moderate cases and (iii) Antidepressants should be discontinued after recovery from the depressive episode, and maintained only in those who repeatedly relapse after antidepressant discontinuation (a minority we judge to represent only about 15-20% of bipolar depressed patients).作者: france 时间: 04-4-15 20:07
从那里摘的啊。作者: 精灵娃娃 时间: 04-4-15 20:42
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14636365&dopt=Abstract
Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up.
Altshuler L, Suppes T, Black D, Nolen WA, Keck PE Jr, Frye MA, McElroy S, Kupka R, Grunze H, Walden J, Leverich G, Denicoff K, Luckenbaugh D, Post R.
Stanley Bipolar Treatment Network, USA. laltshuler@mednet.ucla.edu
OBJECTIVE: While guidelines for treating patients with bipolar depression recommend discontinuing antidepressants within 6 months after remission, few studies have assessed the implications of this strategy on the risk for depressive relapse. This study examined the effect of antidepressant discontinuation or continuation on depressive relapse risk among bipolar subjects successfully treated for an acute depressive episode. METHOD: Eighty-four subjects with bipolar disorder who achieved remission from a depressive episode with the addition of an antidepressant to an ongoing mood stabilizer regimen were followed prospectively for 1 year. The risk of depressive relapse among 43 subjects who stopped antidepressant treatment within 6 months after remission ("discontinuation group") was compared with the risk among 41 subjects who continued taking antidepressants beyond 6 months ("continuation group"). RESULTS: A Cox proportional hazards regression analysis indicated that shorter antidepressant exposure time following successful treatment was associated with a significantly shorter time to depressive relapse. Furthermore, patients who discontinued antidepressant treatment within the first 6 months after remission experienced a significantly shorter period of euthymia before depressive relapse over the length of 1-year follow-up. One year after successful antidepressant response, 70% of the antidepressant discontinuation group experienced a depressive relapse compared with 36% of the continuation group. By the 1-year follow-up evaluation, 15 (18%) of the 84 subjects had experienced a manic relapse; only six of these subjects were taking an antidepressant at the time of manic relapse. CONCLUSIONS: The risk of depressive relapse in patients with bipolar illness was significantly associated with discontinuing antidepressants soon after remission. The risk of manic relapse was not significantly associated with continuing use of antidepressant medication and, overall, was substantially less than the risk of depressive relapse. Maintenance of antidepressant treatment in combination with a mood stabilizer may be warranted in some patients with bipolar disorder.作者: 精灵娃娃 时间: 04-4-15 21:55
可以清心
对于抗抑郁药物的服用引起快速循环的倾向，是对于双向的人才成立的。
而抗抑郁药物的单独使用，是不是单纯就能引起狂躁，我是看到过一些这样的个案，但是我的理解是这样的人本来就是有狂躁的倾向的，只是在抑郁缓解以后才明显表现，我也是这样的类型。很少有人一开始就知道自己是双向的，一般都是从单向的抑郁开始的。
快速循环情感障碍其实也是双向的一种，占5%-15%。具体概念如下。
● In Rapid-Cycling Bipolar Disorder, a person has at least 4
episodes per year, in any combination of manic, hypomanic,
mixed, or depressive episodes. This course pattern is seen in
approximately 5% to 15% of patients with bipolar disorder. It is
sometimes associated with use of antidepressants without mood
stabilizers, which may increase cycling. For unknown reasons,
the rapid-cycling subtype of bipolar disorder is more common in
women.作者: 望海山人 时间: 04-4-19 19:34
现在都成专家了作者: 可以清心 时间: 04-4-19 22:44
提示: 作者被禁止或删除 内容自动屏蔽作者: ayaa 时间: 04-4-20 14:16
是啊，清心得问题也是我得问题。
精灵娃娃，在时间久了，是如何有经验得那。
能讲讲过程吗
是如何个久法那
如果没有 正确诊断为双相，
会有什么后果那；。作者: 精灵娃娃 时间: 04-4-21 08:55
可以清心，
双向，如果是轻微狂躁的类型，在情绪好的时候，自己很难作出GOOD DAY和轻微狂躁之间的判断，你周围的父母或者朋友的判断也许会稍微客观一点。当局者迷。
每个人的情况不一样，对于双向的人，随着对自己情况的了解，会明白如何区分GOOG DAY OR BAD DAY 与抑郁或者狂躁的不同。这样的经验是需要发病的实践来积累的，虽然有点残酷。作者: 精灵娃娃 时间: 04-4-21 09:01
ayaa，
双向的人比单纯抑郁的人治疗要麻烦。我希望你是单向的，因为你做的测试只有3分。如果你的感觉大部分时间都是这样的，那么医生的判断非常有可能是正确的。