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Yıl:2011; Cilt: 5; Sayı: 1-3>> Özet
TAM METİN
Psikiyatride Derlemeler, Olgular ve Varsayımlar (RCHP); 2011;5(1-3):19-24
“İki Uçlu Bozukluk-III” Diye Bir Klinik Durum Var mı?
A Ünal, HA Savaş
Gaziantep Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı / Gaziantep
It is a known fact that antidepressant treatment causes manic or hypomanic switches. These tables that form as a result of antidepressant medication is not referred to in the DSM-IV and the ICD-10, and have no authentic diagnostic tools. The term “bipolar disorder III" is occasionally used to define the mania or hypomania caused by using antidepressants. At present, the term bipolar is assessed on a large spectrum. This spectrum defines mood disorders that include episodes of hypomania/mania and depression at different levels and severity, previously defined as manic-depressive. Whether the manic/hypomanic switch based on antidepressants is a side effect of using this medication or whether it illustrates that the individual has a tendency towards bipolar disorders is a long-standing argument. Within this framework, various studies have been conducted to compare the clinical properties of hypomania that develops with medication and hypomania that develops spontaneously.. In conclusion, mania or hypomania episodes may occur during antidepressant treatment applied to unipolar depression. The fact that there are clinical similarities between hypomania caused by antidepressants and hypomania that develops naturally, and that patients treated due to diagnosis of unipolar depression and having emotion shifts eventually have bipolar disorder support the view that patients that develop mania or hypomania while using medication are “actually patients with bipolar disorders." Antidepressant drugs, proved by many studies to be ineffective during the depressive period of bipolar disorders, also have an adverse effect on the course of bipolar disorders. The subject of “hypomania triggered by antidepressants", must be re-evaluated in the DSM-V.
Is There a Clinical Status Named “Bipolar Disorder-III ?”
Antidepresan tedavilerin manik ya da hipomanik kaymalara neden olabildigi bilinmektedir. Antidepresan ilaçlara bagli ortaya çikan bu tablolar DSM-IV ile ICD-10’da yer almamakta ve özgün tani ölçütleri bulunmamaktadir. Antidepresan ilaç kullanimi ile ortaya çikan mani ya da hipomani için “iki uçlu bozukluk III” terimi zaman zaman kullanilmaktadir. Günümüzde iki uçluluk kavrami genis bir yelpazede degerlendirilmektedir. Bu yelpaze, eskiden manik-depresif olarak tanimlanan, degisik siddet ve dereceleri olan depresyon ve hipomani/mani döngülerinin oldugu duygudurum bozukluklarini tanimlamaktadir. Antidepresan ilaçlara bagli manik/hipomanik kaymanin bu ilaçlarin kullanimi ile iliskili bir yan etki mi yoksa iki uçlu bozukluga yatkinligi mi gösterdigi konusu uzunca süredir tartisilmaktadir. Bu çerçevede, çok sayida çalismada ilaca bagli gelisen hipomani ile kendiliginden ortaya çikan hipomani klinik özelliklerine göre karsilastirilarak farkli yönleri ortaya konulmaya çalisilmistir. Sonuç olarak, tek uçlu depresyonun antidepresan ilaç tedavisi sirasinda mani ya da hipomani dönemleri ortaya çikabilmektedir. Tek uçlu depresyon tanisi ile antidepresan ilaç tedavisi baslanan ve duygulanim kaymasi gözlenen hastalarin sonunda yüksek oranda iki uçlu bozukluga geçmesi ve kendiliginden olan hipomani ile antidepresanlarin neden oldugu hipomani arasindaki klinik benzerlikler olmasi, ilaç kullanimi sirasinda mani ya da hipomani yasayan hastalarin gerçekte, “iki uçlu bozuklugu olan hastalar" olduklari görüsünü desteklemektedir. Iki uçlu bozukluk depresif dönemde etkisiz oldugu çok sayida çalisma ile gösterilen antidepresan ilaçlar, iki uçlu bozuklugun seyrini de olumsuz olarak etkileyebilirler. “Antidepresanin tetikledigi hipomani" konusunun DSM-V’te yeniden degerlendirmesi gerekmektedir.

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