不同类型抗抑郁剂在双相抑郁治疗中导致转相的回顾性研究

目的比较不同抗抑郁剂在双相抑郁治疗过程中转相率的差异。方法对150例接受抗抑郁剂治疗的双相抑郁患者出现躁狂、轻躁狂、快速循环情况进行调查，并比较不同抗抑郁剂之间的差异。结果150例双相抑郁中，共有41例患者在治疗过程中转相，总发生率（转相率）34％。其中使用双重作用抗抑郁剂（DAA）患者的转相率为29．2％，使用选择性5-羟色胺回吸收抑制剂〈SSRI）的患者为12.7％，DAA与SSRI联合应用者为48．7％，三组间差异有统计学意义（Χ^2=11．87，P〈0．001）。DDA与SSRI联合应用者转相率高于SSRI，差异有统计学意义（Χ^2=16．06，P〈0．001，危险比OR=6．53）；DAA转相率高于SSRI。差异有统计学意义（Χ^2=4.65，P〈0．01，OR=6．53）；DAA与SSRI联合应用者转相率高于DAA（Χ^2=3．49，P〉0.05，OR=2．31）。转相与未转相者相比，心境稳定剂的应用差异有统计学意义（7／41，52／109，Χ^2=11．72，P〈0．001）。结论不同类型抗抑郁荆在双相抑郁治疗中引起的转相率有差异，其中联合使用抗抑郁剂的转相率最高，而心境稳定剂的联合应用有助于预防转相。

Retrospective study on switching rate of different antidepressants in the treatment of bipolar depression

Objective To investigate switching rate associated with antidepressants in patients with biplar depression. Methods A total of 150 patients enrolled the trial ,and the rate of svchching mania,hypomania and rapid cycling during treatment with antidepressants was analysed. Results The switching rate of 150 patients with bipolar disorders was 34%, and rate of dual action antidepressants（DAA） was 29.2%, selective serotonin reuptake inhibitor（SSRI） was 12.7%, DAA combined with SSRI was 48.7%（Χ^2= 17.87, P〈0. 001）, and significant differences were found among them. The significant difference in usage of mood stabilizers was also found between the switching patients and non-switching patients. Conclusion The differences on switching rate in treatment of bipolar depression by various antidepressants exist,in which highest rate associating with DAA combined with SSRI. Usage of mood stabilizer may prevent this switching.