阿莫达非尼
阿莫达非尼是一种获准用于治疗发作性睡病的精神兴奋药。作为治疗双相抑郁的一种辅助治疗，该药物也显示出了效果；然而，在成为可接受的治疗之前仍需进一步的研究。[95]Calabrese JR, Ketter TA, Youakim JM, et al. Adjunctive armodafinil for major depressive episodes associated with bipolar I disorder: a randomized, multicenter, double-blind, placebo-controlled, proof-of-concept study. J Clin Psychiatry. 2010 Oct;71(10):1363-70.http://www.ncbi.nlm.nih.gov/pubmed/20673554?tool=bestpractice.com
氯胺酮
单次给药亚麻醉剂量氯胺酮（一种广泛使用的麻醉剂）可改善难治性抑郁患者的抑郁症状。[134]Zarate CA Jr, Singh JB, Carlson PJ, et al. A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry. 2006 Aug;63(8):856-64.https://jamanetwork.com/journals/jamapsychiatry/fullarticle/668195http://www.ncbi.nlm.nih.gov/pubmed/16894061?tool=bestpractice.com 氯胺酮还可以减少双相情感障碍患者的自杀想法和抑郁症状。[135]Zarate CA, Brutsche NE, Ibrahim L, et al. Replication of ketamine's antidepressant efficacy in bipolar depression: a randomized controlled add-on trial. Biol Psychiatry. 2012 Jun 1;71(11):939-46.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343177/http://www.ncbi.nlm.nih.gov/pubmed/22297150?tool=bestpractice.com 该治疗仍然被认为是试验性的，[136]McCloud TL, Caddy C, Jochim J, et al. Ketamine and other glutamate receptor modulators for depression in bipolar disorder in adults. Cochrane Database Syst Rev. 2015 Sep 29;(9):CD011611.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011611.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26415966?tool=bestpractice.com 需要继续研究，以证实重复给予氯胺酮治疗双相抑郁的有效性、安全性和耐受性。在其他患者群体中，重复使用氯胺酮已被证实与泌尿系统和肝毒性、认知缺陷以及依赖性有关。[137]Short B, Fong J, Galvez V, et al. Side-effects associated with ketamine use in depression: a systematic review. Lancet Psychiatry. 2018 Jan;5(1):65-78.http://www.ncbi.nlm.nih.gov/pubmed/28757132?tool=bestpractice.com
经颅直流电刺激 (tDCS)
作为一种通过头部的电极片传递低直流电流刺激大脑的新疗法，经颅直流电刺激 (transcranial direct current stimulation, tDCS) 在单相重性抑郁治疗方面具有前景。一项随机对照试验 (RCT) 研究发现，在 59 例患有双相情感障碍且出现重性抑郁发作的成人患者（已接受稳定的药物治疗方案）中，tDCS 治疗比假性 tDCS 更为有效。在这项研究中，此治疗似乎是安全且耐受良好。[138]Sampaio-Junior B, Tortella G, Borrione L, et al. Efficacy and safety of transcranial direct current stimulation as an add-on treatment for bipolar depression: a randomized clinical trial. JAMA Psychiatry. 2018 Feb 1;75(2):158-66.http://www.ncbi.nlm.nih.gov/pubmed/29282470?tool=bestpractice.com 现在需要更大规模的多点 RCT 来进一步检查 tDCS 在治疗双相情感障碍方面的有效性和安全性。
