Abstract
Background: prescribing antidepressants in the treatment of bipolar depression remains highly controversial due to the inconsistence between routine clinical practice and the results of controlled trials. Purpose: to assess the validity of antidepressants use in bipolar depression from the point of view of evidence-based medicine. Material: database search (Scopus and MEDLINE) followed by analysis of studies concerning the efficacy and safety of antidepressants in bipolar depression treatment. Сonclusion: the search found 23 studies. There was a high degree of inconsistency in the results, apparently related to the methodology. Only two studies compared the effectiveness of antidepressants in monotherapy with placebo, with no differences found in the study with 740 participants and in the study with 70 participants with type 2 bipolar disorder antidepressants were found to be more effective than placebo. Nevertheless, both studies had significant methodological issues. In 6 studies comparing the effectiveness of the combination of antidepressants with mood stabilizers against the combination of mood stabilizers with placebo, only the effectiveness of fluoxetine in combination with olanzapine was revealed, other antidepressants were ineffective. At the same time, studies where antidepressants were compared with each other in combination with mood stabilizers revealed a significant clinical response to therapy. Analysis of routine clinical practice studies has shown that antidepressants are prescribed very often, for about 50% of patients with bipolar depression. International guidelines for therapy differ quite widely on the use of antidepressants in bipolar depression, but in principle allow their use. Thus, despite the contradictory literature data, the use of antidepressants in bipolar depression is justified from the point of view of evidence-based medicine for certain groups of patients with taking into account risk factors.
Highlights
Psychiatry (Moscow) 18(2)'2020'51-60 often, for about 50% of patients with bipolar depression
Despite the contradictory literature data, the use of antidepressants in bipolar depression is justified from the point of view of evidence-based medicine for certain groups of patients with taking into account risk factors
БАР первого и второго типов, сравнение антидепрессантов с другими препаратами в комбинации с нормотимиком/BD I, II, comparison antidepressants with others drugs combined with normothymic
Summary
Абстракт Обоснование исследования: в настоящее время вопрос назначения антидепрессантов при лечении биполярной депрессии остается весьма спорным в связи с противоречием между рутинной клинической практикой и результатами контролиру- 51 емых исследований. Цель исследования: оценка обоснованности назначения антидепрессантов при биполярной депрессии с точки зрения доказательной медицины. Всего два исследования сравнивали эффективность антидепрессантов в монотерапии с плацебо, при этом в исследовании с 740 участниками отличий найдено не было, в исследовании с 70 участниками с биполярным расстройством 2 типа антидепрессанты оказались эффективнее плацебо. В 6 исследованиях, сравнивавших эффективность сочетания антидепрессантов с нормотимиками против сочетания нормотимиков с плацебо, была выявлена только эффективность флуоксетина в сочетании с оланзапином, другие антидепрессанты оказались неэффективны. Несмотря на противоречивость литературных данных, назначение антидепрессантов при биполярной депрессии является оправданным с точки зрения доказательной медицины для определенных групп пациентов при учете факторов риска. Оправдано ли назначение антидепрессантов при биполярной депрессии с точки зрения доказательной медицины?
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