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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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References

Colom, F., Vieta, E., Martinez-Aran, A., Reinares, M., Benabarre, A., Gasto, C.Clinical factors associated with treatment noncompliance in euthymic bipolar patients. J. Clin. Psychiatry 2000; 61: 549–555CrossRefGoogle ScholarPubMed
Colom, F., Vieta, E., Martínez-Arán, A., Reinares, M., Goikolea, J.M., Benabarre, A., et al.A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch. Gen. Psychiatry 2004; 60: 402–407CrossRefGoogle Scholar
Delbello, M.P., Schwiers, M.L., Rosenberg, H.L., Strakowski, S.M.A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. J. Am. Acad. Child Adolesc. Psychiatry 2002; 41: 1216–1223CrossRefGoogle ScholarPubMed
Denicoff, K.D., Smith-Jackson, E.E., Disney, E.R., Ali, S.O., Leverich, G.S., Post, R.M.Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in bipolar disorder. J. Clin. Psychiatry 1997; 58: 470–478CrossRefGoogle ScholarPubMed
Frye, M.A., Ketter, T.A., Leverich, G.S., Huggins, T., Lantz, C., Denicoff, K.D., et al.The use of combination therapy in patients with bipolar disorder appears to be increasing. J. Clin. Psychiatry 2000; 61: 9–15CrossRefGoogle Scholar
Goldberg, J.F., Burdick, K.E., Endick, C.J.Preliminary randomized, double-blind, placebo-controlled trial of pramipexole added to mood stabilizers for treatment-resistant bipolar depression. Am. J. Psychiatry 2004; 161: 564–566CrossRefGoogle ScholarPubMed
Goodwin, G.M.Evidence-based guidelines for treating bipolar disorder: recommendations from the British Association for Psychopharmacology. J. Psychopharmacol. 2003; 17: 149–173CrossRefGoogle ScholarPubMed
Goodwin, G.M., Sachs, G.Fast facts: bipolar disorder UK: Healthpress; 2004.Google Scholar
Maj, M., Pirozzi, R., Magliano, L., Bartoli, L.Long-term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic. Am. J. Psychiatry 1998; 155: 30–35CrossRefGoogle Scholar
Markar, H.R., Mander, A.J.Efficacy of lithium prophylaxis in clinical practice. Br. J. Psychiatry 1989; 155: 496–500CrossRefGoogle Scholar
Muller-Oerlinghausen, B., Retzow, A., Henn, F.A., Giedke, H., Walden, J.Valproate as an adjunct to neuroleptic medication for the treatment of acute episodes of mania: a prospective, randomized, double-blind, placebo-controlled, multicenter study. European Valproate Mania Study Group. J. Clin. Psychopharmacol. 2000; 20: 195–203CrossRefGoogle ScholarPubMed
Nakagami, T., Qiao, Q., Carstensen, B., Nhr-Hansen, C., Hu, G., Tuomilehto, J., et al.The DECODE DECODA-Study-Group. Age, body mass index and type 2 diabetes-associations modified by ethnicity. Diabetologia 2003; 46: 1063–1070Google Scholar
Post, R.M., Denicoff, K.D., Leverich, G.S., Altshuler, L.L., Frye, M.A., Suppes, T.M., et al.Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. J. Clin. Psychiatry 2003; 64: 680–690CrossRefGoogle ScholarPubMed
Rendell, J.M., Juszczak, E., Hainsworth, J., Gucht, E.V., Healey, C., Morriss, R., et al.Developing the BALANCE trial—the role of the pilot study and start-up phase. Bipolar Disord. 2004; 6: 26–31CrossRefGoogle Scholar
Sabers, A., Dam, M., A-Rogvi-Hansen, B., Boas, J., Sidenius, P., Laue Friis, M., et al.Epilepsy and pregnancy: lamotrigine as main drug used. Acta Neurol. Scand. 2004; 109: 9–13CrossRefGoogle ScholarPubMed
Sachs, G.S., Grossman, F., Ghaemi, S.N., Okamoto, A., Bowden, C.L.Combination of a mood stabilizer with risperidone or haloperidol for treatment of acute mania: a double-blind, placebo-controlled comparison of efficacy and safety. Am. J. Psychiatry 2002; 159: 1146–1154CrossRefGoogle ScholarPubMed
Tohen, M., Chengappa, K.N., Suppes, T., Baker, R.W., Zarate, C.A., Bowden, C.L., et al.Relapse prevention in bipolar I disorder: 18-month comparison of olanzapine plus mood stabiliser v. mood stabiliser alone. Br. J. Psychiatry 2004; 184: 337–345CrossRefGoogle ScholarPubMed
Tohen, M., et al.Presented at: 41st ACNP annual meeting Puerto Rico: San Juan; 2002.Google Scholar
Tohen, M., Hennen, J., Zarate, C.M. Jr., Baldessarini, R.J., Strakowski, S.M., Stoll, A.L., et al.Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features. Am. J. Psychiatry 2000; 157: 220–228CrossRefGoogle ScholarPubMed
Vieta, E.Atypical antipsychotics in the treatment of mood disorders. Curr. Opin. Psychiatry 2003; 16: 23–27CrossRefGoogle Scholar
Vieta, E.Maintenance therapy for bipolar disorder: current and future management options. Expert Rev. Neurother. 6Suppl2004 35–42CrossRefGoogle Scholar
Vieta, E.Improving treatment adherence in bipolar disorder through psychoeducation. J. Clin. Psychiatry 66Suppl 12005 24–29Google ScholarPubMed
Vieta, E., Colom, F.Psychological interventions in bipolar disorder: From wishful thinking to an evidence-based approach. Acta Psychiatr. Scand. Suppl. 2004;422:(2004)34–38CrossRefGoogle Scholar
Vieta, E., Sanchez-Moreno, J., Goikolea, J.M., Colom, F., Martinez-Aran, A., Benabarre, A., et al.Effects on weight and outcome of long-term olanzapine-topiramate combination treatment in bipolar disorder. J. Clin. Psychopharmacol. 2004; 24: 374–378CrossRefGoogle ScholarPubMed
Yatham, L.N., Grossman, F., Augustyns, I., Vieta, E., Ravindran, A.Mood stabilisers plus risperidone or placebo in the treatment of acute mania. International, double-blind, randomised controlled trial. Br. J. Psychiatry 2003; 182: 141–147CrossRefGoogle ScholarPubMed
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