Clinical practice recommendations for bipolar disorder

Malhi, Gin S; Adams, Danielle; Lampe, Lisa; Paton, Michael; O’Connor, Nick; Newton, Lesley; Walter, Garry; Taylor, Anne; Porter, Richard; Mulder, Roger; Berk, Michael

doi:10.1111/j.1600-0447.2009.01383.x

Cited by 104 publications

(92 citation statements)

References 163 publications

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“…Guidelines for the pharmacologic treatment of depressive states currently recommend several types of treatment, including mood stabilizers, atypical antipsychotics, and antidepressants [27,28]. The choice of whether to use an antidepressant or an atypical antipsychotic in bipolar depression would be facilitated by distinguishing inhibited/emotional hyporeactive depression from activated/emotional hyperreactive depression.…”

Section: Inhibition/activation Behavioral Level and Emotional Reactivmentioning

confidence: 99%

New Ways to Classify Bipolar Disorders: Going from Categorical Groups to Symptom Clusters or Dimensions

Henry

Étain

2010

Curr Psychiatry Rep

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Current psychiatric disorder classifications are based exclusively on categorical models, which were designed to increase the reliability of diagnoses. However, this system has some limitations, and various psychiatric disorders may be classified using a dimensional approach, which is more appropriate when no clear boundaries exist between entities or when examining various features on a continuum. Thus, the forthcoming DSM-5 appears to be undertaking a hybrid approach by including categorical models associated with dimensions. We aim to review examples of dimensions or symptom clusters associated with a categorical approach that could be useful in refining bipolar disorder classification. We selected predominant polarity, psychotic symptoms, inhibition/activation behavioral level, and emotional reactivity to define mood episodes, impulsivity/suicidality/substance misuse, and cognitive impairment. The selection was based on the fact that these dimensions or symptom clusters are currently being discussed to be implemented in the DSM-5 and/or may orientate toward the choice of specific treatments and represent more homogeneous and thus more appropriate subgroups for research purposes. In the future, there will be a need to identify biomarkers that can definitively validate the use of these criteria.

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Section: Inhibition/activation Behavioral Level and Emotional Reactivmentioning

confidence: 99%

New Ways to Classify Bipolar Disorders: Going from Categorical Groups to Symptom Clusters or Dimensions

Henry

Étain

2010

Curr Psychiatry Rep

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“…These observations, and the realization that the treatment of bipolar disorder is essentially the treatment of bipolar depression, underscore the need for its effective and prompt management. Therefore, in this paper we briefly review the evidence for the use of medications in the treatment of bipolar depression, given that, since the middle of the 20th century, pharmacotherapy has formed the crux of its management and features prominently in contemporary clinical practice guidelines (32)(33)(34)(35)(36). Further, we propose that when managing bipolar depression, it is essential to keep maintenance in mind and, in particular, to consider the long-term prophylactic efficacy and tolerability of agents when selecting treatment for acute depression.…”

Section: Burden Of Illnessmentioning

confidence: 99%

Medicating mood with maintenance in mind: bipolar depression pharmacotherapy

2009

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Objectives: Bipolar depression is a core feature of bipolar disorder, a phase in which many patients spend the majority of time and one that confers a significant degree of burden and risk. The purpose of this paper is to briefly review the evidence base for the pharmacotherapy of bipolar depression and to discuss the recommendations for its optimal management.Methods: A detailed literature review was undertaken with a particular emphasis on pharmacological treatment strategies for bipolar depression across the acute and maintenance phases of the illness. Electronic library and Web‐based searches were performed using recognised tools (MEDLINE, PubMED, EMBASE and PsychINFO) to identify the pertinent literature. A summary of the evidence base is outlined and then distilled into broad clinical recommendations to guide the pharmacological management of bipolar depression.Results: Partitioning treatment into acute and maintenance therapy is difficult based on the paucity of current evidence. The evidence from treatment trials favours the use of lithium and lamotrigine as first‐line treatment in preference to valproate, and indicates that, for acute episodes, quetiapine and olanzapine have perhaps achieved equivalence at least in terms of efficacy. However, the effectiveness of the atypical antipsychotics in maintenance therapy is constrained by the potential for significant side effects of individual agents and the lack of both long‐term research data and clinical experience in treating bipolar disorder as compared to other agents. Conversely, lithium and the anticonvulsants are generally slower to effect symptomatic change, and this limits their usefulness.Conclusions: There has been a tendency for research trials of bipolar depression to differentiate the illness cross‐sectionally into the acute and maintenance phases of bipolar depression; however, in clinical terms, bipolar depression invariably follows a longitudinal course in which the phases of illness are inextricably linked, and useful acute treatments are typically continued in maintenance. Therefore, when medicating mood in acute bipolar depression it is imperative to keep maintenance in mind as it is this aspect of treatment that determines long‐term success.

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“…However, most existing international clinical practice guidelines on the management of BAD provide limited and somewhat contradictory recommendations regarding lithium dosing. 6,7,[10][11][12] For example, the American Psychiatric Association states that SDD regimens may improve peak-related adverse effects, such as tremor, help manage polyuria, and facilitate compliance. 7 However, they also state that lithium is usually started in divided doses to minimize adverse effects.…”

Section: Limitationsmentioning

confidence: 99%

An Updated Review of the Optimal Lithium Dosage Regimen for Renal Protection

2013

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Objective: Despite several decades of research, there is still uncertainty regarding the optimal lithium dosage regimen associated with a decreased risk of renal effects, such as polyuria, in patients with bipolar affective disorder. We present an updated review of the literature to provide an informed dosing regimen recommendation for prescribers. Method:Major databases MEDLINE and Embase were searched using terms, such as lithium, drug administration schedule, dose-response relationship, once daily, twice daily, and sustained release. In addition, the bibliographies of related publications were manually searched.Results: A total of 20 trials were included. Some trials showed a reduction in urine volume with single daily dosing (SDD), while others showed no change. The only trial evaluating patients newly started on lithium found a reduction in urinary frequency with SDD after 21 days. Trials examining renal biopsy results found that multiple daily doses were associated with more pathologic damage to the kidneys. SDD regimens were generally well tolerated, and no reduction in efficacy was noted in any of the trials. Conclusions:The available evidence is contradictory as to whether SDD of lithium reduces polyuria; however, no trial has demonstrated any downfall of SDD in terms of prophylactic efficacy or adverse effects. Given the added benefits of SDD, such as improved compliance, we recommend patients newly started on lithium should be converted to a SDD of lithium at bedtime once an appropriate daily dose is determined. W W WUne revue mise à jour de la posologie optimale du lithium pour la protection rénale Objectif : Malgré plusieurs décennies de recherche, il y a encore de l'incertitude concernant la posologie optimale du lithium associée au risque réduit d'effets rénaux, comme la polyurie, chez les patients souffrant du trouble bipolaire affectif. Nous présentons une revue mise à jour de la littérature afin d'offrir aux prescripteurs une recommandation éclairée de régime posologique.Méthode : Cette recherche a été menée à partir des grandes bases de données MEDLINE et Embase à l'aide de termes comme : lithium, horaire d'administration des médicaments, relation dose-réponse, une fois par jour, deux fois par jour, et libération prolongée. En outre, les bibliographies de publications connexes ont fait l'objet d'une recherche manuelle.Résultats : Un total de 20 essais ont été inclus. Certains essais montraient une réduction du volume d'urine avec une dose unique quotidienne (DUQ), alors que d'autres n'indiquaient aucun changement. Le seul essai qui évaluait les patients qui commençaient le lithium a observé une réduction de la fréquence urinaire avec la DUQ après 21 jours. Les essais examinant les résultats de biopsie rénale ont constaté que les doses multiples quotidiennes étaient associées à plus de dommages pathologiques aux reins. Les posologies de DUQ étaient généralement bien tolérées, et aucune réduction d'efficacité n'a été notée dans tous les essais. Conclusions :Les données probantes disponibles sont...

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Clinical practice recommendations for bipolar disorder

Abstract: These up-to-date recommendations provide an evidence-based framework that incorporates clinical wisdom and consideration of individual factors in the management of bipolar disorder. Further, the novel style and practical approach should promote their uptake and implementation.

Cited by 104 publications

References 163 publications

New Ways to Classify Bipolar Disorders: Going from Categorical Groups to Symptom Clusters or Dimensions

New Ways to Classify Bipolar Disorders: Going from Categorical Groups to Symptom Clusters or Dimensions

Medicating mood with maintenance in mind: bipolar depression pharmacotherapy

An Updated Review of the Optimal Lithium Dosage Regimen for Renal Protection

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