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Effective maintenance treatment—breaking the cycle of bipolar disorder

Published online by Cambridge University Press:  16 April 2020

Guy Goodwin  and
Eduard Vieta
Guy Goodwin*
Affiliation:
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
Eduard Vieta
Affiliation:
Hospital Clinic, University of Barcelona, Barcelona, Spain
*
*Corresponding author. Tel.: +44 1 865 226451; fax: +44 1 865 204198. E-mail address:[email protected] (G. Goodwin)
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Abstract

Clinical guidelines for treatment and research of bipolar disorder greatly benefit from the synthesis of data from individual studies. The British Association for Psychopharmacology bases its guidelines on evidence from opinions (level D) to systematic reviews of primary trial data (level A). The report details conclusions of its 1-day consensus meeting to develop guidelines covering diagnosis, clinical management, pharmacotherapy for acute episodes, relapse prevention and treatment discontinuation. Monotherapy for long-term management is preferred, having reduced side-effects and drug interactions and improved compliance. Combination therapy is often preferred for acute episodes, using antipsychotics for mania or antidepressants for depression. Increased efficacy may be attributed to multiple mechanisms of action and potentially lower doses. In clinical practice, maintenance monotherapy has limited success for chronic episodes and polypharmacy is frequently used, though the best combination remains unclear. A new collaborative approach based on simple clinical trials is required to change current medical practice.

Keywords

Bipolar disorderDivalproateGuidelinesLithiumMaintenance therapyOlanzapine
Type
Original article
Information
European Psychiatry , Volume 20 , Issue 5-6 , August 2005 , pp. 365 - 371
Copyright
Copyright ©Elsevier SAS 2005

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