拉莫三嗪治疗双相心境障碍对照研究

目的：探讨拉莫三嗪治疗双相情感障碍的疗效与安全性。方法：双相心境障碍患者135例，其中双相抑郁78例，躁狂57例。将患者随机分为3组，每组抑郁相26例，躁狂相19例。疗程32周。前8周为急性期治疗阶段，对照组抑郁相只服选择性5-羟色胺回收抑制剂（SSRI）类抗抑郁剂，躁狂相只服利培酮；拉莫三嗪组在对照组用药的基础上加服拉莫三嗪；碳酸锂组在对照组用药的基础上加服碳酸锂。后24周为巩固治疗阶段，所有患者随机分为两组，只服拉莫三嗪或碳酸锂。采用汉密尔顿抑郁量表（HAMD）、Young躁狂评定量表（YMRS）、治疗中出现的症状量表（TESS）评定疗效及安全性。结果：急性期治疗结束后，无论躁狂相还是抑郁相，拉莫三嗪组和碳酸锂组的临床疗效显著高于对照组（P〈0．01或〈0．05）。巩固治疗阶段两组相比，拉莫三嗪的抗抑郁作用较好，碳酸锂的抗躁狂作用较强。不良反应发生率，碳酸锂组40％，拉莫三嗪组22％。巩固治疗阶段病情复发率，拉莫三嗪组8％，碳酸锂组11％，两组差异无显著性（P〉0．05）。结论：拉莫三嗪作为心境稳定剂治疗双相情感障碍疗效可靠，不良反应小，与碳酸锂相比，抗抑郁作用更强。

A control study of lamotrigine in the trealment of bipolar mood disorder

Objective:To explore the efficacy and safety of lamotrigine in the treatment of bipolar mood disorder.Method:135 patients with bipolar mood disorder were enrolled in the study for 32 weeks,among them 78 patients with bipolar depressive disorder and 57 patients with bipolar manic disorder.In the first 8 weeks,regarded as acute period,all patients were randomly divided into three groups,control group,lamotrigine group and lithium group,with each group including 26 patients with bipolar depressive disorder and 19 patients with bipolar manic disorder.Patients were treated with selective serotonin reuptake inhibitors(SSRI)for bipolar depressive disorder and risperidone for bipolar manic disorder in control group.Patients in lamotrigine group were treated with SSRI plus lamotrigine for bipolar depressive disorder and risperidone plus lamotrigine for bipolar manic disorder.Patients in lithium group were treated with SSRI plus lithium for bipolar depressive disorder and risperidone plus lithium for bipolar manic disorder.In later 24 weeks,regarded as maintain treatment period,all patients were randomly divided into two groups,lamotrigin group(lamotrigine treatment only)and lithium group(lithium treatment only).Hamilton depressive scale(HAMD)and Young manic rating scale(YMRS)to evaluate the efficacy and treatment emergent symptom scale(TESS)to evaluate the safety.Results:Patients in lamotrigine group or lithium group,whatever being bipolar depressive disorder or bipolar manic disorder,had better clinical efficacy than those in control group at the end of acute treatment period(P<0.01 or P<0.05).Lamotrigine and lithium were better in treating depression and manic respectively in the later maintain treatment period when the two groups compared,with the rate of adverse effect 40% for lithium group and 22% for lamotrigine group.As for the recurrent rate in maintain treatment period,there was no significant difference between lamotrigine group and lithium group(8% vs.11%,P>0.05).Conclusion:Lamotrigine,as a mood stabilizer,had better efficacy and less adverse effects in the treatment of bipolar mood disorder,especially better in treating depression when compared with lithium.