nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2016-2-36-43nnp-606Research ArticleORIGINAL INVESTIGATIONSОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ И МЕТОДИКИTherapy for depression in bipolar affective disorderТерапия депрессии при биполярном аффективном расстройствеТювинаН. А.TyuvinaN. A.

Кафедра психиатрии и наркологии 

119021, Москва, ул. Россолимо, 11, стр. 9

Department of Psychiatry and Narcology

11, Rossolimo St., Build. 9, Moscow 119021 

natuvina@yandex.ruКоробковаИ. Г.KorobkovaI. G.

Кафедра психиатрии и наркологии 

119021, Москва, ул. Россолимо, 11, стр. 9

Department of Psychiatry and Narcology

11, Rossolimo St., Build. 9, Moscow 119021 

ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России, МоскваРоссияI.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, MoscowRussian Federation201616072016823643Copyright © Tyuvina N.A., Korobkova I.G., 20162016Тювина Н.А., Коробкова И.Г.Tyuvina N.A., Korobkova I.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/606Objective

Objective: to evaluate the efficiency and safety of different therapy regimens for depression in relation to the clinical type of bipolar affective disorders (BAD) and to choose optimal treatment regimens for depression in BAD type I (BADI) and BAD type II (BADII).

Patients and methods

Patients and methods. A total of 65 depressive patients, including 25 with BADI and 37 with BADII, were examined. 212 depressive episodes were analyzed in BAD patients, of them there were 74 with BADI and 138 with BADII. The patients with BADI took a combination of an antidepressant (AD) and a normothymic (NT), NT and a neuroleptic (NL), AD, NT and NL. Those with BADII received monotherapy with AD or NL, a combination of AD + NT, AD + NL. The patients' status was clinically evaluated using a specially designed questionnaire and the MADRS and CGI psychometric scales at baseline and then at the end of 1, 2, 4, and 8 weeks of therapy.

Results

Results. The AD-containing regimens used to treat patients with BADI proved to be more effective; this therapy led to a more marked reduction in depressive symptoms (55.73% in the AD + NT-treated patients; 54.07% in the AD + NT + NL group versus 33.64% in the NT + NL-treated patients), a higher response to therapy, and a larger number of remissions by the end of the investigation (80.0, 72.7, and 33.3%, respectively). Moreover, the incidence of transient hypomanic symptoms did not significantly differ in these groups (20.0, 27.3, and 8.3%, respectively). The depressive patients with BADII generally responded better to different therapy regimens (the reduction in depressive symptoms was 52.08, 58.82, 58.40, and 53.98% in the AD, NL, AD + NT, and AD + NL groups; the remission index by the end of the investigation was 60.6, 92.9, 77.8, and 69.2%, respectively); these patients were seen to have less frequently symptoms of an antipole during their treatment (18.2, 7.1, 0.0, and 15.4%, respectively).

Conclusion

Conclusion. The incorporation of AD into a therapy regimen in BAD patients accelerates emergence from any depression severity and considerably enhances the efficiency of treatment. According to the clinical picture of depression, both AD monotherapy (BADII) and a combination of AD + NT and/or NL (BADI, BADII) may be used. The incorporation of AD into a therapy regimen does not significantly increase a risk for developing an inverse phase. 

Цель исследования – оценить эффективность и безопасность различных схем терапии депрессии в зависимости от клинического варианта биполярного аффективного расстройства (БАР) и выбрать оптимальные схемы лечения депрессии при БАР I типа (БАР I) и БАР II типа (БАР II).

Пациенты и методы

Пациенты и методы. Обследовано 62 больных с депрессией: 25 – с БАР I и 37 – с БАР II. Проведены анализ и лечение 212 депрессивных эпизодов у больных с БАР, из них 74 при БАР I и 138 при БАР II. Больные с БАР I получали комбинацию антидепрессанта (АД) и нормотимика (НТ), НТ и нейролептика (НЛ), АД, НТ и НЛ. При БАР II применяли монотерапию АД либо НЛ, комбинацию АД + НТ, АД + НЛ. Состояние больных оценивалось клинически с использованием специально разработанного опросника, а также с помощью психометрических шкал MADRS и CGI в начале исследования и затем в конце 1-й, 2-й, 4-й и 8-й недели терапии.

Результаты

Результаты. При лечении пациентов с БАР I схемы, включавшие АД, оказались более эффективными, такая терапия сопровождалась более выраженной редукцией депрессивной симптоматики (55,73% у получавших схему АД + НТ, 54,07% – АД + НТ + НЛ против 33,64% у леченных НТ + НЛ), более высоким ответом на терапию и большим числом ремиссий к концу исследования (80,0; 72,7 и 33,3% соответственно). При этом частота возникновения симптомов транзиторной гипомании в этих группах достоверно не различалась (20,0; 27,3 и 8,3% соответственно). Пациенты с депрессией в рамках БАР II в целом лучше отвечали на различные схемы терапии (степень редукции депрессивной симптоматики – 52,08% у получавших АД, 58,82% – НЛ, 58,40% – АД + НТ, 53,98% – АД + НЛ; показатель ремиссий к концу исследования – 60,6; 92,9; 77,8 и 69,2% соответственно), у них реже отмечались симптомы противоположного полюса на фоне лечения (18,2; 7,1; 0,0 и 15,4% соответственно).

Заключение

Заключение. У пациентов с БАР введение в схему терапии АД ускоряет выход из депрессии любой тяжести и значительно повышает эффективность лечения. В зависимости от клинической картины депрессии может применяться как монотерапия АД (БАР II), так и комбинация АД + НТ и/или НЛ (БАР I, БАР II). Включение в схему терапии АД достоверно не повышает риск развития инверсии фазы. 

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The authors declare that there are no conflicts of interest present.