Tratamento da depressão bipolar
DOI:
https://doi.org/10.25118/2763-9037.2011.v1.877Palavras-chave:
TB, transtorno bipolar, depressão, tratamento, medicação, antipsicóticos, antidepressivos, estabilizadores de humorResumo
Embora o estado maníaco seja a condição definidora do diagnóstico de transtorno bipolar, o estado depressivo é a condição sintomática mais frequente na vida do paciente e o responsável pela maior parte da incapacitação e sofrimento gerados ao portador de transtorno bipolar (Goodwin & Jamison, 2007). Em um estudo de seguimento de 10 anos, pacientes com transtorno bipolar tipo I estiveram deprimidos em 31% do tempo, mais do que em mania (9%) ou em estados mistos (9%) (Judd et al., 2003a). Pacientes com transtorno bipolar tipo II estiveram em depressão em 50,3% do tempo, muito mais do que em hipomania (1,3%) (Judd et al., 2003b). Cerca de 50% dos pacientes com transtorno bipolar tem um episódio depressivo como a primeira manifestação da doença, e os episódios depressivos podem ser crônicos em 20% dos pacientes e serem mais refratários ao tratamento do que episódios maníacos ou hipomaníacos (Yatham et al., 2005). A depressão bipolar, seja o episódio depressivo, sejam os sintomas subsindrômicos, contribui ainda com grande parte da perda de funcionalidade e qualidade de vida do paciente com transtorno bipolar (Goodwin & Jamison, 2007).
Downloads
Métricas
Referências
Goodwin FK, Jamison KR. Manic-Depressive Illness: Bipolar Disorder and Recurrent Depression. 2nd ed. New York: Oxford University Press; 2007.
Judd LL, Akiskal HS, Schetter PJ, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2003; 59: 530-537. DOI: https://doi.org/10.1001/archpsyc.59.6.530
Judd LL, Akiskal HS, Schettler PJ, et al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003; 60: 261-269. DOI: https://doi.org/10.1001/archpsyc.60.3.261
Yatham LN, Kennedy SH, O’Donovan C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disord 2005; Suppl 3:5-69. DOI: https://doi.org/10.1111/j.1399-5618.2005.00219.x
Ghaemi SN. Why antidepressants are not antidepressants: STEP-BD, STAR*D, and the return of neurotic depression. Bipolar
Disord 2008; 10: 957-968. DOI: https://doi.org/10.1111/j.1399-5618.2008.00639.x
Perlis RH, Brown E, Baker RW, et al. Clinical features of bipolar depression versus major depressive disorder in large multicenter
trials. Am J Psychiatry 2006; 163: 225-231. DOI: https://doi.org/10.1176/appi.ajp.163.2.225
Abreu LN, Lafer B, Baca-Garcia E, Oquendo MA. Suicidal ideation and suicide attempts in bipolar disorder type I: an update for the clinician. Rev Bras Psiquiatr 2009; 31: 271-280. DOI: https://doi.org/10.1590/S1516-44462009005000003
Malhi S, Adams D, Berk M. Medicating mood with maintenance in mind: bipolar depression pharmacotherapy. Bipolar Disord 2009; Suppl 2: 55-76. DOI: https://doi.org/10.1111/j.1399-5618.2009.00711.x
Yatham LN, Kennedy SH, Schaffer A, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International
Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disord 2009; 11: 225-255. DOI: https://doi.org/10.1111/j.1399-5618.2009.00672.x
Zornberg GL, Pope HG Jr. Treatment of depression in bipolar disorder: new directions for research. J Clin Psychopharmacol
; 13: 397-408.
Frye MA, Ketter TA, Kimbrell TA, et al. A placebo-controlled study of lamotrigine and gabapentin monotherapy in refractory
mood disorders. J Clin Psychiatry 2000; 20: 607-614. DOI: https://doi.org/10.1097/00004714-200012000-00004
Calabrese JR, Huffman RF, White RL, et al. Lamotrigine in the acute treatment of bipolar depression: results of fivedouble-blind, placebo-controlled clinical trials. Bipolar Disord 2008; 10: 323-33. DOI: https://doi.org/10.1111/j.1399-5618.2007.00500.x
Geddes JR, Calabrese JR, Goodwin GM. Lamotrigine for treatment of bipolar depression: independent meta-analysis and
meta-regression of individual patient data from five randomised trials. Br J Psychiatry 2009; 194: 4-9. DOI: https://doi.org/10.1192/bjp.bp.107.048504
van der Loos ML, Mulder P, Hartong EG, et al. Efficacy and safety of two treatment algorithms in bipolar depression consisting
of a combination of lithium, lamotrigine or placebo and paroxetine. Acta Psychiatr Scand 2010; 122: 246-54. DOI: https://doi.org/10.1111/j.1600-0447.2009.01537.x
Ghaemi SN, Gilmer WS, Goldberg JF, et al. Divalproex in the treatment of acute bipolar depression: a preliminary double-
-blind, randomized, placebo-controlled pilot study. J Clin Psychiatry 2007; 68: 1840-1844. DOI: https://doi.org/10.4088/JCP.v68n1203
Muzina DJ, Gao K, Kemp DE, et al. Acute efficacy of divalproex sodium versus placebo in mood stabilizer-naïve bipolar
I or II depression: a double-blind, randomized, placebo-controlled trial. J Clin Psychiatry 2010; 24: Epub ahead of print.
Small JG. Anticonvulsants in affective disorders. Psychopharmacol Bull 1990; 26: 25-36.
Calabrese JR, Keck PE, Macfadden W, et al. A randomized double blind placebo controlled trial of quetiapine in the treatment
of bipolar I and II depression. Am J Psychiatry 2005; 162: 1351-1360. DOI: https://doi.org/10.1176/appi.ajp.162.7.1351
Thase ME, Macfadden W, Weisler RH, et al. Efficacy of quetiapine monotherapy in bipolar I and II depression: a double-
-blind, placebo-controlled study (the BOLDER II study). J Clin Psychopharmacol 2006; 26: 600-609. DOI: https://doi.org/10.1097/01.jcp.0000248603.76231.b7
Tohen M, Vieta E, Calabrese J, et al. Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatry 2003; 60: 1079-1088. DOI: https://doi.org/10.1001/archpsyc.60.11.1079
Tamayo JM, Zarate CA Jr, Vieta E, et al. Level of response and safety of pharmacological monotherapy in the treatment of acute bipolar I disorder phases: a systematic review and meta-analysis. Int J Neuropsychopharmacol 2010; 18: 813-832. DOI: https://doi.org/10.1017/S1461145709991246
Tamada RS, Issler CK, Amaral JA, Sachs GS, Lafer B. Treatmentemer gent affective switch: a controlled study. Bipolar Disord 2004; 6: 333-7. DOI: https://doi.org/10.1111/j.1399-5618.2004.00124.x
Baldessarini RJ, Vieta E, Calabrese JR, et al. Bipolar depression: overview and commentary. Harv Rev Psychiatry 2010; 18: DOI: https://doi.org/10.3109/10673221003747955
-157.
Post RM, Altshuler LL, Leverich GS, et al. Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropionand sertraline. Br J Psychiatry 2006; 189: 124-131. DOI: https://doi.org/10.1192/bjp.bp.105.013045
Nemeroff CB, Evans DL, Gyulai L, et al. Double-blind, placebo-controlled comparisons of imipramine and paroxetine in the treatment of bipolar depression. Am J Psychiatry 2001; 158: 906-912. DOI: https://doi.org/10.1176/appi.ajp.158.987.906
Macedo-Soares MB, Moreno RA, Rigonatti SP, Lafer B. Efficacy of electroconvulsive therapy in treatment-resistant bipolar
disorder: a case series. J ECT 2005; 21: 31-4. DOI: https://doi.org/10.1097/01.yct.0000148621.88104.f1
Nery FG, Monkul ES, Hatch JP, Fonseca M, Zunta-Soares GB, Frey BN, Bowden CL, Soares JC. Celecoxib as an adjunct in the treatment of depressive and mixed episodes of bipolar disorder: a double-blind, randomized, placebo-controlled study. Hum Psychopharmacol 2008; 23: 87-94. DOI: https://doi.org/10.1002/hup.912
Frye MA, Grunze H, Suppes T, et al. A placebo-controlled study of adjunctive modafinil in the treatment of bipolar depression.
Am J Psychiatry 2007; 164: 1242-1249.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2011 Beny Lafer, Fabiano G. Nery
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial 4.0 International License.
Debates em Psiquiatria permite que o (s) autor (es) mantenha(m) seus direitos autorais sem restrições. Atribuição-NãoComercial 4.0 Internacional (CC BY-NC 4.0) - Debates em Psiquiatria é regida pela licença CC-BY-NC