Prophylactic treatment response in bipolar disorder: Results of a naturalistic observation study

Garnham, Julie; Munro, Allana; Slaney, Claire; MacDougall, Marsha; Passmore, Michael J.; Duffy, Anne; O′Donovan, Claire; Teehan, Andrew; Alda, Martin

doi:10.1016/j.jad.2007.03.003

Cited by 165 publications

(152 citation statements)

References 29 publications

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“…For instance, an episodic course of BP has generally been positively correlated with response. Garnham and colleagues performed a retrospective chart review of 120 patients with BP who were treated in an outpatient setting [Garnham et al 2007]. Among the 78 lithium treatment trials considered, a full response to lithium was observed 30% of the time, whereas the rate of partial improvement was 58%.…”

Section: Bipolar Disordermentioning

confidence: 99%

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Predictors of lithium response in bipolar disorder

Tighe

Mahon

Potash

2011

Therapeutic Advances in Chronic Disease

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While lithium is generally regarded as the first-line agent for patients with bipolar disorder, it does not work for everyone, which raises the question: can we predict who will be most likely to respond? In this paper, we review the most compelling clinical, biologic, and genetic predictors of lithium response in bipolar disorder. Among clinical factors, the strongest predictors of good response are fewer hospitalizations preceding treatment, an episodic course characterized by an illness pattern of mania followed by depression, and a later age at onset of bipolar disorder. While several biologic predictors have been studied, the results are preliminary and require replication with studies of larger patient samples over longer observation periods. Neuroimaging is a particularly promising method given that it might concurrently illuminate pathophysiologic underpinnings of bipolar disorder, the mechanism of action of lithium, and potential predictors of lithium response. The first genome-wide association study of lithium response was recently completed. No definitive results emerged, perhaps because the study was underpowered. With major new initiatives in progress aiming to identify genes and genetic variations associated with lithium response, there is much reason to be hopeful that clinically useful information might be generated within the next several years. This could ultimately translate into tests that could guide the choice of mood-stabilizing medication for patients. In addition, it might facilitate pharmacologic research aimed at developing newer, more effective medications that might act more quickly and yield fewer side effects.

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Section: Bipolar Disordermentioning

confidence: 99%

“…More recently, Duffy, and colleagues examined 15 adolescents who met criteria for bipolar spectrum disorder and had a parent with BP. Nine of the adolescents were observed to have a positive response to lithium treatment; this observation was associated with lithium responsiveness in the parents [Duffy et al 2007]. …”

Section: Bipolar Disordermentioning

confidence: 99%

Predictors of lithium response in bipolar disorder

Tighe

Mahon

Potash

2011

Therapeutic Advances in Chronic Disease

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“…For example, despite the current wisdom that early-onset BD represents a more severe form of illness that likely will require polypharmacy, evidence suggests that even earlyonset disorder can be stabilized with selected monotherapy, chosen on the basis of family history of psychiatric disorders and treatment response in other affected family members, alongside the clinical course of the patient and developmental history [17,[20][21][22].…”

Section: Observations In Patients With Established Illnessmentioning

confidence: 99%

Interventions for Youth at Risk of Bipolar Disorder

Duffy

2014

Curr Treat Options Psych

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Opinion statementWith the recognition that bipolar disorder (BD) develops in a series of predictable clinical stages, clinical and research focus has shifted increasingly into early intervention and prevention. The heritability of BD is estimated to be around 85 %; therefore, children of affected parents are an identifiable and important high-risk group. Lessons from early psychosis and other areas of medicine suggest that education for high-risk families regarding recognizable clinical stages and modifiable risk factors are a reasonable starting place. Specifically, reinforcing the importance of healthy nutrition, cardiovascular exercise, maintaining normal body mass index, and healthy coping strategies are important topics to cover. Early risk syndromes include sleep and anxiety disorders, which should be addressed with low-risk treatments, including sleep hygiene and individual psychotherapy. Typically, adolescence marks the age of onset of depressive disorders related to the bipolar diathesis. This is also the time when poor coping through substance abuse emerges. It is very important when assessing a depressed adolescent to understand the familial risk of psychiatric disorders. While psychotherapy is typically effective for mild non-psychotic depression, the acute treatment of moderate-severe major depression in adolescents and young adults with a confirmed family history of BD is a topic of considerable debate. The treatment decision should be taken together with the patient and family, with full discussion of the risks and potential benefits. Options include a closely monitored trial of low-dose antidepressant, discontinued immediately upon resolution of the depressive episode, or mood stabilizer that fits the patient profile, or a combination of these two, in addition to psychotherapy and reducing modifiable risk factors. When a high-risk subject manifests a diagnosable manic or hypomanic episode (typically years after the first depressive episode in late adolescence or adulthood) the question arises of whether to initiate prophylactic treatment. Potential candidates are those with a high recurrence risk and/or concern about the recurrence of a severe episode. Research has shown that most patients can be stabilized, with selected monotherapy individualized on the basis of the nature of the clinical course (episodic vs. non-episodic), quality of the spontaneous remission, and family history of psychiatric disorders and treatment response.Novel adjunctive treatments including nutraceuticals, antioxidants, and anti-inflammatory agents are being studied and may be helpful in high-risk individuals during the early stages of illness development.

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“…To illustrate this point, in conservatively defined BD, the efficacy of lithium has been estimated at 75%, 8 but this number drops considerably to about 30% for patients diagnosed according to the current criteria. 9 The diagnostic criteria for BD expanded starting with DSM-III and we have argued that this is partly responsible for reduced response rates. 10 In other words, as BD has been redefined as a more heterogeneous condition, the diagnostic expansion may have led to more frequent diagnosis of BD in patients with atypical illness who are less likely to respond to lithium.…”

Section: Diagnosis Of Bdmentioning

confidence: 99%

Beyond the Guidelines for Bipolar Disorder: Practical Issues in Long-Term Treatment with Lithium

Calkin

Alda

2012

Can J Psychiatry

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Objective: Several treatment guidelines are available for clinicians working with patients with bipolar disorder (BD), but some of the more nuanced aspects of lithium therapy go beyond the scope of such guidelines. Therefore, in this perspective, our objective was to focus on specific practical issues of lithium treatment, including the selection and initiation of long-term treatment, and management and discontinuation (if indicated) of lithium prophylaxis. Method:We conducted a focused review of the relevant literature on the treatment of BD.Results: Consultation requests to a BD specialty service often relate to issues for which there is limited evidence, including when to initiate long-term treatment, whether choice of mood stabilizer is specific, how long to treat acute episodes, whether to switch or add on medication when treatment fails, how long to continue effective treatment, and what medication to use when a lithium-responsive patient must discontinue lithium. Conclusion:Optimal long-term treatment of BD will require more research as well as better alignment of clinical and training programs. W W WObjectif : Plusieurs guides de traitement sont offerts aux cliniciens qui travaillent auprès de patients souffrant du trouble bipolaire (TB), mais certains des aspects plus nuancés de la thérapie par le lithium vont au-delà de la portée de ces guides. Par conséquent, dans cette optique, notre objectif était de mettre l'accent sur des questions pratiques spécifiques du traitement par lithium, notamment la sélection et l'initiation d'un traitement à long terme, et la gestion et l'interruption (si indiqué) d'un traitement préventif par lithium.Méthode : Nous avons mené une revue ciblée de la littérature pertinente sur le traitement du TB.Résultats : Les demandes de consultation à un service spécialisé en TB ont souvent trait aux questions pour lesquelles les données probantes sont limitées, notamment, le moment d'initier un traitement à long terme, si le choix d'un régulateur de l'humeur est spécifique, combien de temps traiter les épisodes aigus, s'il faut changer de médicament ou en ajouter lorsque le traitement échoue, combien de temps continuer un traitement efficace, et quel médicament utiliser quand un patient qui répond bien au lithium doit arrêter le lithium. Conclusion :Le traitement à long terme optimal du TB exigera plus de recherche ainsi qu'une meilleure harmonisation des programmes cliniques et de formation.

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Prophylactic treatment response in bipolar disorder: Results of a naturalistic observation study

Cited by 165 publications

References 29 publications

Predictors of lithium response in bipolar disorder

Predictors of lithium response in bipolar disorder

Interventions for Youth at Risk of Bipolar Disorder

Beyond the Guidelines for Bipolar Disorder: Practical Issues in Long-Term Treatment with Lithium

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