Drug Therapy in the Prevention of Recurrences in Unipolar and Bipolar Affective Disorders

Prien, Robert F.

doi:10.1001/archpsyc.1983.01790220086014

Cited by 551 publications

(142 citation statements)

References 16 publications

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“…Tricyclic antidepressant mono or adjunctive maintenance therapy is not recommended due to an increased risk of manic switch (level 2 negative)398, 399, 400 (Table 18). …”

Section: Maintenance Therapy For Bipolar Disordermentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…Tricyclic antidepressant mono or adjunctive maintenance therapy is not recommended due to an increased risk of manic switch (level 2 negative)398, 399, 400 (Table 18). …”

Section: Maintenance Therapy For Bipolar Disordermentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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“…This is not an insignificant problem since recurrence rates vary from 15 to 40% in long-term clinical trials, a proportion mirrored in clinical practice (Coppen et al, 1978;Prien et al, 1973Prien et al, , 1984Montgomery et al, 1988;Rouillon et al, 1989;Frank et al, 1990;Doogan and Caillard, 1992;Kupfer et al, 1992;Montgomery and Dunbar, 1993). Patients who relapse in spite of continuing their treatment may be demoralized and refuse further treatment.…”

Section: Introductionmentioning

confidence: 99%

Placebo-Controlled Continuation Treatment with Mirtazapine: Acute Pattern of Response Predicts Relapse

Nierenberg

Quitkin

Kremer³

et al. 2004

Neuropsychopharmacol

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Pattern of response to antidepressants has been proposed as a method to identify patients whose improvement is more likely due to drug vs those whose improvement on drug is more likely to be a placebo effect. It is hypothesized that those with 'true-drug initial response pattern' are most likely to benefit from continuation treatment. The relationship between acute patterns of response and subsequent placebo-controlled continuation treatment with the antidepressant mirtazapine is examined. A total of 410 outpatients were treated openly with mirtazapine for 8-12 weeks. Patients who remitted in the acute phase were randomized to continue the same dose of mirtazapine or switched to placebo. Acute phase responders were classified as 'placebo initial response pattern' (early responders and nonpersistent responders) and 'true-drug initial response pattern' (delayed and persistent responders). Of those with a 'true-drug initial response pattern,' 10/40 (25.0%) relapsed with continuation mirtazapine, and 23/41 (56.1%) relapsed when switched to placebo. The difference (31.1%) is significant. Of those with a 'placebo initial response pattern,' 5/36 (13.9%) relapsed with continuation mirtazapine, and 12/39 (30.8%) relapsed with placebo substitution. This difference (16.9%) is not statistically significant. Moreover, the relapse rate for 'true-drug initial response pattern' patients switched to placebo (56.1%) was also significantly greater than for 'placebo initial response pattern' patients switched to placebo (30.8%). It has been suggested that patients with late onset and persistence are more likely to have improved because of drug. This hypothesis gains support from this study because of the different relapse rates of 'true-drug' responders on drug and placebo. The low relapse rate for patients with an acute placebo pattern switched to placebo suggests specific drug effect played a smaller role in their initial improvement.

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“…On the other hand, two studies have reported that lithium and imipramine have comparable efficacy in the prevention of recurrence (Glen et al 1981;Prien et al 1984) whereas one study has shown imipramine to be superior to lithium in long term maintenance treatment of unipolar depression (Frank et al 1990). The difference in conclusions reached by these various studies may be explained by several factors including, as Prien et al (1984) have noted, differences in the patients studied. In those reports in which lithium was shown to be superior to a cyclic antidepressant, patients were more stable at the point of entry into the study and had been episode free for at least 7 to 12 months.…”

Section: Maintenance Treatmentmentioning

confidence: 98%

“…To date, three studies have shown that lithium is superior to a heterocyclic antidepressant in the prevention of recurrence (Coppen et al 1976b; Kane et al 1982;. On the other hand, two studies have reported that lithium and imipramine have comparable efficacy in the prevention of recurrence (Glen et al 1981;Prien et al 1984) whereas one study has shown imipramine to be superior to lithium in long term maintenance treatment of unipolar depression (Frank et al 1990). The difference in conclusions reached by these various studies may be explained by several factors including, as Prien et al (1984) have noted, differences in the patients studied.…”

Section: Maintenance Treatmentmentioning

confidence: 99%

Pharmacotherapy of Depression

Ciraulo¹,

Shader²

2004

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Drug Therapy in the Prevention of Recurrences in Unipolar and Bipolar Affective Disorders

Cited by 551 publications

References 16 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Placebo-Controlled Continuation Treatment with Mirtazapine: Acute Pattern of Response Predicts Relapse

Pharmacotherapy of Depression

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