Balanced efficacy, safety, and tolerability recommendations for the clinical management of bipolar disorder

Abstract

The current paper summarises the treatment recommendations relating to each phase of bipolar disorder while providing additional, evidence-based, practical insights. Medication-related side effects and monitoring strategies highlight the importance of safety and tolerability considerations, which, along with efficacy information, should be given equal merit.

Maintaining mood stability in bipolar disorder: a clinical perspective on pharmacotherapy

“…It has shown efficacy as monotherapy and as an adjunct to lithium in reducing the risk of recurrence, particularly of depression 4 19–21 . Carbamazepine is another option that has shown some efficacy predominantly as an adjunct,22 but due to its side effect burden, should be considered only after more readily-tolerated agents fail to yield benefits 3…”

Safety and tolerability of antipsychotic-mood stabilizer co-treatment in the management of acute bipolar disorder: results from a systematic review and exploratory meta-analysis

“…This review summarized the available results of studies on AEs comparing MS+AP cotreatment with AP and MS monotherapy, and finding that the AE risk is higher in patients receiving co-treatment, both in general and also pertaining to many specific AEs. Based on these results, efficacy advantages of co-treatment strategies need to be evaluated in light of potential AE disadvantages, which requires that clinicians routinely assess both efficacy and safety/tolerability of the frequently occurring combination therapies in patients with BD [48] and take into account the potential pharmacokinetic drug--drug interactions between MS and AP [23,25,49,50]. Furthermore, the finding, although based on a very small set of studies and indirect comparisons, that addition of MS to APs is associated with a lower AE burden than the reverse should be followed up in studies that concurrently assess efficacy and tolerability of both augmentation strategies.…”

Mindfulness improves psychological quality of life in community-based patients with severe mental health problems: A pilot randomized clinical trial

“…antipsychotics or mood stabilizers) is accepted as the base of the treatment plan (Gardner and Bostwick, 2012;Malhi et al, 2012). Nevertheless pharmacotherapy has several limitations: unwanted side effects (i.e.…”