Treatment for Bipolar Disorder in Adults: A Systematic Review

Abstract

Purpose of Review• To assess the effectiveness of drug and nondrug therapies for treating acute mania or depression symptoms and preventing relapse in adults with bipolar disorder (BD) diagnoses, including bipolar I disorder (BD-I), bipolar II disorder (BD-II), and other types. Key Messages• Acute mania treatment: Lithium, asenapine, cariprazine, olanzapine, quetiapine, risperidone, and ziprasidone may modestly improve acute mania symptoms in adults with BD-I. Participants on atypical antipsychotics, except for quetiapine, reported more extrapyramidal symptoms, and those on olanzapine reported more weight gain, compared with placebo. • Maintenance treatment: Lithium may prevent relapse into acute episodes in adults with BD-I. • Depression treatment: Evidence was insufficient for drug treatments for depressive episodes in adults with BD-I and BD-II. • For adults with any BD type, cognitive behavioral therapy may be no better than other psychotherapies for improving acute bipolar symptoms and systematic/collaborative care may be no better than other behavioral therapies for preventing relapse of any acute symptoms. • Stronger conclusions were prevented by high rates of participants dropping out.This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied. This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at www.effectivehealthcare.ahrq.gov. Search on the title of the report.

Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications

“…Food and Drug Administration approved anticonvulsants for the treatment of bipolar disorder in adults; they are carbamazepine, valproate, lamotrigine [176].…”

Hospital utilization rates following antipsychotic dose reduction in mood disorders: implications for treatment of tardive dyskinesia

“…Although MDD is more prevalent in the population, antipsychotics are particularly effective and commonly started during the acute phase of mania in BD [13]. Despite the fact that evidence on the long-term effectiveness and safety of antipsychotics in these episodic and remitting disorders is limited, many patients remain on antipsychotics chronically and perhaps unnecessarily [3,11,12,[14][15][16][17].…”

Demographics and Clinical Profiles of Patients Visiting a Free Clinic in Miami, Florida

“…In our study population, we found that the most prevalent mental health disorders were depression and anxiety, with the former substantially exceeding county estimates in males (14.1 vs. 12.5%, p = 0.0047). Furthermore, while county level data were not available, our patients appeared to have higher rates of both bipolar disorder (3.5 vs. 2–3%) (42–44) and schizophrenia (2.5 vs. 0.4%) (45) compared to national estimates in the general population. These findings agree with previous studies that have indeed suggested that the overall rate of psychiatric disorders is elevated amongst both the uninsured (46) as well as the homeless (47, 48).…”