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Review
. 2024 Nov 29:48:101135.
doi: 10.1016/j.lanepe.2024.101135. eCollection 2025 Jan.

Bipolar disorders: an update on critical aspects

Vincenzo Oliva  1   2   3 , Giovanna Fico  1   2   3 , Michele De Prisco  1   2   3   4 , Xenia Gonda  5   6 , Adriane R Rosa  7   8   9 , Eduard Vieta  1   2   3   4
Affiliations
Review

Bipolar disorders: an update on critical aspects

Vincenzo Oliva et al. Lancet Reg Health Eur. .

Abstract

Bipolar disorders are chronic psychiatric conditions characterized by recurrent episodes of mania and depression. Affecting over 1% of the global population, these disorders contribute significantly to disability and mortality, often due to suicide and cardiovascular disease. Diagnostic challenges arise from symptom overlap with unipolar depression, frequently leading to delays. Bipolar disorders are driven by complex genetic, neurobiological, and environmental factors and are commonly accompanied by psychiatric and medical comorbidities, further complicating diagnosis and treatment. Standard management strategies include mood stabilizers, antipsychotics, and selective use of antidepressants, complemented by psychosocial interventions like cognitive-behavioral therapy and psychoeducation, which are vital for relapse prevention. Despite recent advancements, the management of bipolar disorders remains challenging, constrained by clinical variability, an absence of specific biomarkers, and differences in approved treatments and treatment guidelines across regions. Emerging research underscores the potential of precision psychiatry and digital health tools to enhance diagnosis and treatment. Nonetheless, critical gaps persist, particularly in implementing equitable care worldwide. This review offers a comprehensive update on bipolar disorders, examining clinical presentation, early diagnosis, pathogenesis, therapeutic strategies, and future perspectives to guide clinicians and researchers in addressing these ongoing challenges in research and clinical practice.

Funding: None.

Keywords: Bipolar depression; Bipolar disorders; Mania; Mental health; Precision psychiatry; Review; Treatment.

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Conflict of interest statement

GF served as a paid consultant for Lundbeck. EV has received grants and served as a paid consultant, advisor, or CME speaker for AB-Biotics, Abbott, AbbVie, Adamed, Angelini, Biogen, Biohaven, Boehringer Ingelheim, Cambridge University Press, Casen-Recordati, Celon, Compass, Dainippon Sumitomo, Elsevier, Ethypharm, Ferrer, Galenica, Gedeon Richter, GH Research, Glaxo-Smith Kline, Janssen, Lundbeck, Medincell, Merck, Neuraxpharm, Newron, Novartis, Oxford University Press, Orion, Organon, Otsuka, Roche, Rovi, Sage, Sanofi-Aventis, Sunovion, Takeda, Teva, and Viatris, out of the submitted work.

Figures

Fig. 1
Fig. 1
Lifechart showing progression of bipolar disorders and recommended pharmacological treatments. LAI, Long acting injectable. Li, Lithium; SSRI, Selective serotonin reuptake inhibitor; VLP, Valproate. ∗Valproate should be avoided in patients of childbearing age due to its teratogenic risk and other significant side effects.
See this image and copyright information in PMC

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