MEDIX, God. 14 Br. 77 Supplement 1  •  Pregledni članak  •  Psihijatrija HR ENG

Liječenje akutne faze bipolarnog afektivnog poremećajaPharmacologic treatment of acute bipolar affective disorder

Ljubomir Hotujac, Martina Rojnić Kuzman

Farmakološko liječenje akutne faze bipolarnog afektivnog poremećaja provodi se primarno stabilizatorima raspoloženja. Različite strategije su opisane kroz algoritme. U slučaju neuspjeha monoterapije, alternativne strategije uključuju kombinacije. U liječenje manične i hipomanične epizode od stabilizatora raspoloženja koriste se litij, valproati, karbamazepin, ali i drugi stabilizatori raspoloženja: gabapentin, pregabalin, topiramat, tiagabin. U prvu liniju liječenja uključeni su i antipsihotici druge generacije (olanzapin, risperidon, kvetiapin, ziprasidon i aripiprazol). Liječenje depresivne epizode provodi se primarno lamotriginom. U slučaju terapijske rezistencije na lamotrigin, poželjno je kombinirati više stabilizatora raspoloženja, ili uz stabilizatore raspoloženje dodati antipsihotik druge generacije ili antidepresiv. Nije poželjno liječiti depresivnu fazu BAP-a monoterapijom antidepresivima

Ključne riječi:
antidepresivi, antipsihotici, bipolarni poremećaj, farmakoterapija

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 14 Br. 77 Supplement 1

Pharmacologic treatment of acute bipolar affective disorder primarily includes mood stabilisers. There are several treatment strategies and algorithms. In case of treatment resistance to monotherapy, alternative strategies with drug combinations are recommended. Mood stabilisers used in the treatment of manic and hypomanic episodes are lithium, valproic acid and carbamazepine, but also gabapentin, pregabalin, topiramate and tiagabine. Second-generation antipsychotics (olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole) are used as the first-line treatment for manic episode of bipolar affective disorder. Lamotrigine is the most recommended treatment for depressive episodes of bipolar affective disorder. In case of resistance to lamotrigine, combinations of mood stabilizers or second-generation antipsychotics combined with antidepressants are recommended. Antidepressant monotherapy should not be the first choice for the treatment of depressive episodes of bipolar affective disorder. 

Key words:
antidepressive agents, antipsychotic agents, bipolar disorder, drug therapy