Practice Guideline for the Treatment of Patients With Bipolar Disorder (Revision)

Hirschfeld, Robert M. A.; Bowden, Charles L.; Gitlin, Michael; Keck, Paul E.; Perlis, Roy H.; Suppes, Trisha; Thase, Michael E.; Wagner, Karen Dineen

doi:10.1176/foc.1.1.64

Cited by 255 publications

(218 citation statements)

References 343 publications

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“…11 A number of methodological factors may explain this unanticipated result, including the requirement of more consistent euthymia in subjects and the use of a non-enriched sample (in contrast to later studies evaluating olanzapine 12 and lamotrigine 13 in which study design utilized an enriched sample). Nonetheless, clinical consensus, Expert Consensus Guidelines, 14 published algorithms 15 and Practice Guidelines 16 all support the efficacy of valproate as a first-line maintenance treatment in bipolar disorder.…”

Section: First-line Treatments For Bipolar Disordermentioning

confidence: 99%

“…Practice Guidelines/Expert Consensus panels or Treatment Algorithms [14][15][16] recommend mood stabilizers, specifically lithium or lamotrigine as first-line treatments for bipolar I depression. For severe depression, lithium or lamotrigine plus an antidepressant should be considered.…”

Section: First-line Treatment Of Bipolar Depressionmentioning

confidence: 99%

“…For severe depression, lithium or lamotrigine plus an antidepressant should be considered. 14,16 For bipolar II depression, however, either lamotrigine or lithium plus an antidepressant has been recommended. 14 Another first-line option for acute bipolar I depression is olanzapine/fluoxetine combination (OFC), which has been shown to be significantly more effective than placebo or olanzapine alone.…”

Section: First-line Treatment Of Bipolar Depressionmentioning

confidence: 99%

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Treatment-resistant bipolar disorder

2006

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Despite the remarkable increase in medications validated as effective in bipolar disorder, treatment is still plagued by inadequate response in acute manic or depressive episodes or in long-term preventive maintenance treatment. Established first-line treatments include lithium, valproate and second-generation antipsychotics (SGAs) in acute mania, and lithium and valproate as maintenance treatments. Recently validated treatments include extended release carbamazapine for acute mania and lamotrigine, olanzapine and aripiprazole as maintenance treatments. For treatment-resistant mania and as maintenance treatments, a number of newer anticonvulsants, and one older one, phenytoin, have shown some promise as effective. However, not all anticonvulsants are effective and each agent needs to be evaluated individually. Combining multiple agents is the most commonly used clinical strategy for treatment resistant bipolar patients despite a relative lack of data supporting its use, except for acute mania (for which lithium or valproate plus an SGA is optimal treatment). Other approaches that may be effective for treatment-resistant patients include high-dose thyroid augmentation, clozapine, calcium channel blockers and electroconvulsive therapy (ECT). Adjunctive psychotherapies show convincing efficacy using a variety of different techniques, most of which include substantial attention to education and enhancing coping strategies. Only recently, bipolar depression has become a topic of serious inquiry with the dominant controversy focusing on the place of antidepressants in the treatment of bipolar depression. Other than mood stabilizers alone or the combination of mood stabilizers and antidepressants, most of the approaches for treatment-resistant bipolar depression are relatively similar to those used in unipolar depression, with the possible exception of a more prominent place for SGAs, prescribed either alone or in combination with antidepressants. Future work in the area needs to explore the treatments commonly used by clinicians with inadequate research support, such as combination therapy and the use of antidepressants as both acute and adjunctive maintenance treatments for bipolar disorder. With the first report of lithium's efficacy in 1949 by Cade, bipolar disorder has the longest record of treatment efficacy among the major Axis I disorders. Furthermore, after more than half a century of clinical research, multiple agents from many different pharmacological classes have shown at least some efficacy, while many other agents (albeit without a consistent database demonstrating their utility) are prescribed regularly by clinicians. Yet, despite this plethora of choices, treatment of bipolar disorder remains suboptimal from the points of view of clinicians and patients alike. Whether measured by recovery time from manic or depressive episodes or preventive efficacy of maintenance treatments, bipolar disorder is characterized by sluggish responses, inadequate responses, poor compliance and recurrences in controlled cli...

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Section: First-line Treatments For Bipolar Disordermentioning

confidence: 99%

Section: First-line Treatment Of Bipolar Depressionmentioning

confidence: 99%

Section: First-line Treatment Of Bipolar Depressionmentioning

confidence: 99%

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Treatment-resistant bipolar disorder

2006

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“…Psychotropic is considered as gold standard approach regarding treatment of bipolar disorder; aside from aforementioned approach various studies have highlighted role of CBT as promising psychotherapeutic approach regarding this malady. More pharmacologic options are now available, and psychoeducation, self-help, and psychotherapy (individual, couple, and family) interventions are frequently utilized [4].…”

Section: Introductionmentioning

confidence: 99%

Is History of Suicidal Behaviour Related to Social Support and Coping Skills in Patients with Bipolar-I Disorder?

Mazaheri¹

2017

EJPM

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“…Ghaemi et al (1) reported that 80% of patients use antidepressants in some period of their lives after being diagnosed as bipolar disorder; however, only 50% reported using mood stabilizers (MS). It was also suggested that using antidepressants in bipolar depression may lead to manic switches and rapid cycling and may become ineffective in treatment (2,3). In the systematic review of Gijsman et al (4) published in 2004, only 24% of patients with depression adequately responded to antidepressants.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of antidepressant choices for the treatment of depressive symptoms in patients with bipolar disorder / İki uçlu bozukluğu olan hastalarda depresif belirtilerin tedavisinde antidepresan tercihlerinin değerlendirilmesi

Atagün¹,

Altınbaş²,

Yeşilyurt³

et al. 2012

Dusunen Adam

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Evaluation of antidepressant choices for the treatment of depressive symptoms in patients with bipolar disorderObjective: Antidepressants are thought to cause manic switches and accelerate cycling in the treatment of bipolar depression. On the other hand, other evidence suggests that antidepressant neither cause manic switches, nor are effective for the treatment of bipolar depression. This study aimed to assess clinicians' attitudes towards antidepressant choices for treatment of bipolar depressive episodes and subthreshold depression. Methods: Medical records of 784 patients with bipolar disorder were investigated retrospectively. Antidepressants were used in 55 of 263 depressive episodes (20.9%). Data regarding 78 episodes (23 subthreshold symptoms, 55 episodes) of 68 patients (54 female, 14 male; mean age: 39.64±10.99) were obtained. Descriptive statistics were the evaluation method. Results: In our department, antidepressants were used in 20.9% of the patients in the treatment of bipolar depression. One third of patients receiving antidepressant prescriptions had a history of manic switch, 5 (21.7%) of the patients with subthreshold symptoms receiving antidepressant prescriptions had a history of manic switch. However, manic switch occurred in only 5 (6.4%) patients. Selective serotonin reuptake inhibitors were the most common cause (58.3%) of the manic switch in patients with a history of manic switch. Discussion: Clinicians are still using antidepressants in the treatment of bipolar depression. Antidepressants targeting many neurotransmitter systems can be used in the first line treatments and antidepressants can be used even in patients with a history of manic switch. This controversial topic should be studied prospectively with larger samples and it must be clarified whether this phenomenon is a natural course of the disorder or triggered by antidepressant medications. Key words: Bipolar depression, antidepressants, manic switch ÖZET İki uçlu bozukluğu olan hastalarda depresif belirtilerin tedavisinde antidepresan tercihlerinin değerlendirilmesiAmaç: Antidepresanların iki uçlu depresyonda manik kaymalara ve döngü hızlanmasına neden olabilecekleri düşünülmektedir. Diğer taraftan, antidepresanların manik kaymaya neden olmadıklarını, ama etkili de olmadıklarını gösteren araştırmalar bulunmaktadır. Bu araştırmada, uygulamada, klinisyenlerin iki uçlu depresyon tedavisinde antidepresan tercihlerinin ve antidepresan kullanımının sonuçlarının incelenmesi amaçlanmıştır. Yöntem: İki uçlu bozukluk tanısıyla izlenmekte olan 784 hastanın klinik kayıtları, geriye dönük incelendi. 263 depresif dönemin 55'inde (%20.9) antidepresan başlandığı belirlendi. Eşik altı (EA) ve eşik üstü (EÜ) depresif belirtilerin tedavisinde antidepresan eklenen 68 hastaya ait (54 kadın, 14 erkek; ortalama yaş: 39.64±10.99), 78 depresif döneme (23 EA, 55 depresif dönem) ilişkin bulgular kaydedildi. Veriler tanımlayıcı istatistik yöntemlerle değerlendirildi. Bulgular: Merkezimizde depresif dönemleri olan hastalara antidepresan başlam...

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Practice Guideline for the Treatment of Patients With Bipolar Disorder (Revision)

Cited by 255 publications

References 343 publications

Treatment-resistant bipolar disorder

Treatment-resistant bipolar disorder

Is History of Suicidal Behaviour Related to Social Support and Coping Skills in Patients with Bipolar-I Disorder?

Evaluation of antidepressant choices for the treatment of depressive symptoms in patients with bipolar disorder / İki uçlu bozukluğu olan hastalarda depresif belirtilerin tedavisinde antidepresan tercihlerinin değerlendirilmesi

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