A critical appraisal of treatments for bipolar disorder

Abstract

Recovery-the absence of all abnormal mood symptoms-is the goal of treatment for bipolar disorder. Unfortunately, a minority of people suffering from bipolar disorder achieve sustained recovery. Improving recovery rates for this population will require clinicians in the primary care setting to be familiar with appropriate treatments for acute bipolar mania and depression and for the maintenance phase. Efficacy and tolerability of pharmacotherapeutic and psychotherapeutic options for all phases of treatment and each type of mood episode are discussed. Primary care physicians are encouraged to avoid prescribing antidepressant monotherapy for any patient with depression and a history of mania or hypomania.

Figure 1

Atypical Antipsychotic Monotherapy in the Treatment of Acute Mania^{a a}Adapted with permission from Perlis et al. ^bBars represent 95% confidence intervals. The dotted line on the left indicates the pooled difference from placebo among all monotherapy trials. Abbreviation: YMRS = Young Mania Rating Scale.

Figure 2

Severity of Depression for Patients Receiving Lithium and Either Placebo or Lamotrigine^{a a}Reprinted with permission from van der Loos et al. *P = .031. **P = .006. Abbreviation: MADRS = Montgomery-Asberg Depression Rating Scale.

Figure 3

Olanzapine/Fluoxetine Combination as Treatment for Acute Bipolar Depression^{a,b a}Data from Tohen et al. ^bP < .001 for olanzapine vs. placebo for weeks 1 and 4, and for olanzapine/fluoxetine vs. placebo for weeks 1, 4, and 8; P < .01 for olanzapine/fluoxetine vs. olanzapine for weeks 4 and 8. Abbreviation: MADRS = Montgomery-Asberg Depression Rating Scale.

Figure 4

One-Year Survival Rates for Recently Depressed Bipolar I Patients Treated With Lamotrigine, Lithium, or Placebo^{a,b a}Data from Calabrese et al. ^bP = .047 for lamotrigine vs. placebo in depression and P = .026 for lithium vs. placebo in mania.