Pharmacological treatment of adult bipolar disorder
We summarize evidence supporting contemporary pharmacological treatment of phases of BD, including: mania, depression, and long-term recurrences, emphasizing findings from randomized, controlled trials (RCTs). Effective treatment of acute or dysphoric mania is provided by modern antipsychotics, some...
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Veröffentlicht in: | Molecular psychiatry 2019-02, Vol.24 (2), p.198-217 |
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description | We summarize evidence supporting contemporary pharmacological treatment of phases of BD, including: mania, depression, and long-term recurrences, emphasizing findings from randomized, controlled trials (RCTs). Effective treatment of acute or dysphoric mania is provided by modern antipsychotics, some anticonvulsants (divalproex and carbamazepine), and lithium salts. Treatment of BD-depression remains unsatisfactory but includes some modern antipsychotics (particularly lurasidone, olanzapine + fluoxetine, and quetiapine) and the anticonvulsant lamotrigine; value and safety of antidepressants remain controversial. Long-term prophylactic treatment relies on lithium, off-label use of valproate, and growing use of modern antipsychotics. Lithium has unique evidence of antisuicide effects. Methods of evaluating treatments for BD rely heavily on meta-analysis, which is convenient but with important limitations. Underdeveloped treatment for BD-depression may reflect an assumption that effects of antidepressants are similar in BD as in unipolar major depressive disorder. Effective prophylaxis of BD is limited by the efficacy of available treatments and incomplete adherence owing to adverse effects, costs, and lack of ongoing symptoms. Long-term treatment of BD also is limited by access to, and support of expert, comprehensive clinical programs. Pursuit of improved, rationally designed pharmacological treatments for BD, as for most psychiatric disorders, is fundamentally limited by lack of coherent pathophysiology or etiology. |
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Effective treatment of acute or dysphoric mania is provided by modern antipsychotics, some anticonvulsants (divalproex and carbamazepine), and lithium salts. Treatment of BD-depression remains unsatisfactory but includes some modern antipsychotics (particularly lurasidone, olanzapine + fluoxetine, and quetiapine) and the anticonvulsant lamotrigine; value and safety of antidepressants remain controversial. Long-term prophylactic treatment relies on lithium, off-label use of valproate, and growing use of modern antipsychotics. Lithium has unique evidence of antisuicide effects. Methods of evaluating treatments for BD rely heavily on meta-analysis, which is convenient but with important limitations. Underdeveloped treatment for BD-depression may reflect an assumption that effects of antidepressants are similar in BD as in unipolar major depressive disorder. Effective prophylaxis of BD is limited by the efficacy of available treatments and incomplete adherence owing to adverse effects, costs, and lack of ongoing symptoms. Long-term treatment of BD also is limited by access to, and support of expert, comprehensive clinical programs. Pursuit of improved, rationally designed pharmacological treatments for BD, as for most psychiatric disorders, is fundamentally limited by lack of coherent pathophysiology or etiology.</description><identifier>ISSN: 1359-4184</identifier><identifier>EISSN: 1476-5578</identifier><identifier>DOI: 10.1038/s41380-018-0044-2</identifier><identifier>PMID: 29679069</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/699/476/1333 ; 692/699/476/1414 ; Adult ; Adults ; Affective disorders ; Anticonvulsants ; Antidepressants ; Antidepressive Agents - therapeutic use ; Antimanic Agents - therapeutic use ; Antipsychotic agents ; Antipsychotic Agents - therapeutic use ; Antipsychotics ; Behavioral Sciences ; Biological Psychology ; Bipolar disorder ; Bipolar Disorder - drug therapy ; Bipolar Disorder - metabolism ; Carbamazepine ; Care and treatment ; Clinical trials ; Depressive Disorder, Major - drug therapy ; Dosage and administration ; Drug therapy ; Etiology ; Etiology (Medicine) ; Expert Review ; Fluoxetine ; Humans ; Lamotrigine ; Lithium ; Lithium - therapeutic use ; Lithium compounds ; Lithium Compounds - therapeutic use ; Major depressive disorder ; Mania ; Medicine ; Medicine & Public Health ; Mental depression ; Mental disorders ; Neurosciences ; Olanzapine ; Pharmacotherapy ; Preventive medicine ; Prophylaxis ; Psychiatry ; Psychotropic drugs ; Quetiapine ; Reviews ; Salts ; Systematic review ; Tricyclic antidepressants ; Valproic acid</subject><ispartof>Molecular psychiatry, 2019-02, Vol.24 (2), p.198-217</ispartof><rights>Macmillan Publishers Limited, part of Springer Nature 2018</rights><rights>COPYRIGHT 2019 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Feb 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-c014f512c2097910b7f1ba50271f6d7ac73d98fbf570886f615d9216fb18174d3</citedby><cites>FETCH-LOGICAL-c439t-c014f512c2097910b7f1ba50271f6d7ac73d98fbf570886f615d9216fb18174d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29679069$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baldessarini, Ross J.</creatorcontrib><creatorcontrib>Tondo, Leonardo</creatorcontrib><creatorcontrib>Vázquez, Gustavo H.</creatorcontrib><title>Pharmacological treatment of adult bipolar disorder</title><title>Molecular psychiatry</title><addtitle>Mol Psychiatry</addtitle><addtitle>Mol Psychiatry</addtitle><description>We summarize evidence supporting contemporary pharmacological treatment of phases of BD, including: mania, depression, and long-term recurrences, emphasizing findings from randomized, controlled trials (RCTs). Effective treatment of acute or dysphoric mania is provided by modern antipsychotics, some anticonvulsants (divalproex and carbamazepine), and lithium salts. Treatment of BD-depression remains unsatisfactory but includes some modern antipsychotics (particularly lurasidone, olanzapine + fluoxetine, and quetiapine) and the anticonvulsant lamotrigine; value and safety of antidepressants remain controversial. Long-term prophylactic treatment relies on lithium, off-label use of valproate, and growing use of modern antipsychotics. Lithium has unique evidence of antisuicide effects. Methods of evaluating treatments for BD rely heavily on meta-analysis, which is convenient but with important limitations. Underdeveloped treatment for BD-depression may reflect an assumption that effects of antidepressants are similar in BD as in unipolar major depressive disorder. Effective prophylaxis of BD is limited by the efficacy of available treatments and incomplete adherence owing to adverse effects, costs, and lack of ongoing symptoms. Long-term treatment of BD also is limited by access to, and support of expert, comprehensive clinical programs. Pursuit of improved, rationally designed pharmacological treatments for BD, as for most psychiatric disorders, is fundamentally limited by lack of coherent pathophysiology or etiology.</description><subject>692/699/476/1333</subject><subject>692/699/476/1414</subject><subject>Adult</subject><subject>Adults</subject><subject>Affective disorders</subject><subject>Anticonvulsants</subject><subject>Antidepressants</subject><subject>Antidepressive Agents - therapeutic use</subject><subject>Antimanic Agents - therapeutic use</subject><subject>Antipsychotic agents</subject><subject>Antipsychotic Agents - therapeutic use</subject><subject>Antipsychotics</subject><subject>Behavioral Sciences</subject><subject>Biological Psychology</subject><subject>Bipolar disorder</subject><subject>Bipolar Disorder - drug therapy</subject><subject>Bipolar Disorder - metabolism</subject><subject>Carbamazepine</subject><subject>Care and treatment</subject><subject>Clinical trials</subject><subject>Depressive Disorder, Major - drug therapy</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Etiology</subject><subject>Etiology (Medicine)</subject><subject>Expert Review</subject><subject>Fluoxetine</subject><subject>Humans</subject><subject>Lamotrigine</subject><subject>Lithium</subject><subject>Lithium - therapeutic use</subject><subject>Lithium compounds</subject><subject>Lithium Compounds - therapeutic use</subject><subject>Major depressive disorder</subject><subject>Mania</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mental depression</subject><subject>Mental disorders</subject><subject>Neurosciences</subject><subject>Olanzapine</subject><subject>Pharmacotherapy</subject><subject>Preventive medicine</subject><subject>Prophylaxis</subject><subject>Psychiatry</subject><subject>Psychotropic drugs</subject><subject>Quetiapine</subject><subject>Reviews</subject><subject>Salts</subject><subject>Systematic review</subject><subject>Tricyclic antidepressants</subject><subject>Valproic acid</subject><issn>1359-4184</issn><issn>1476-5578</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1kUtP3DAUhS3UisfAD-gGReqGTaiv314iBAUJqV20a8vxYwhK4sFOFvx7PBooKgJ5Ycv3O-de-yD0DfA5YKp-FAZU4RaDajFmrCV76BCYFC3nUn2pZ8p1y0CxA3RUygPG2yLfRwdEC6mx0IeI_r63ebQuDWndOzs0cw52HsM0Nyk21i_D3HT9Jg02N74vKfuQj9HXaIcSTl72Ffp7ffXn8qa9-_Xz9vLirnWM6rl1tV3kQBzBWmrAnYzQWY6JhCi8tE5Sr1XsIpdYKREFcK8JiNiBAsk8XaGzne8mp8cllNmMfXFhGOwU0lIMwURpLiijFf3-Dn1IS57qdIaArH9FKVNv1NoOwfRTTHO2bmtqLrgkAlNe7Vbo_AOqLh_G3qUpxL7e_yeAncDlVEoO0WxyP9r8ZACbbVBmF5SpQZltUIZUzenLwEs3Bv9P8ZpMBcgOKLU0rUN-e9Hnrs8J1ZnK</recordid><startdate>20190201</startdate><enddate>20190201</enddate><creator>Baldessarini, Ross J.</creator><creator>Tondo, Leonardo</creator><creator>Vázquez, Gustavo H.</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20190201</creationdate><title>Pharmacological treatment of adult bipolar disorder</title><author>Baldessarini, Ross J. ; Tondo, Leonardo ; Vázquez, Gustavo H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-c014f512c2097910b7f1ba50271f6d7ac73d98fbf570886f615d9216fb18174d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>692/699/476/1333</topic><topic>692/699/476/1414</topic><topic>Adult</topic><topic>Adults</topic><topic>Affective disorders</topic><topic>Anticonvulsants</topic><topic>Antidepressants</topic><topic>Antidepressive Agents - therapeutic use</topic><topic>Antimanic Agents - therapeutic use</topic><topic>Antipsychotic agents</topic><topic>Antipsychotic Agents - therapeutic use</topic><topic>Antipsychotics</topic><topic>Behavioral Sciences</topic><topic>Biological Psychology</topic><topic>Bipolar disorder</topic><topic>Bipolar Disorder - drug therapy</topic><topic>Bipolar Disorder - metabolism</topic><topic>Carbamazepine</topic><topic>Care and treatment</topic><topic>Clinical trials</topic><topic>Depressive Disorder, Major - drug therapy</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Etiology</topic><topic>Etiology (Medicine)</topic><topic>Expert Review</topic><topic>Fluoxetine</topic><topic>Humans</topic><topic>Lamotrigine</topic><topic>Lithium</topic><topic>Lithium - therapeutic use</topic><topic>Lithium compounds</topic><topic>Lithium Compounds - therapeutic use</topic><topic>Major depressive disorder</topic><topic>Mania</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mental depression</topic><topic>Mental disorders</topic><topic>Neurosciences</topic><topic>Olanzapine</topic><topic>Pharmacotherapy</topic><topic>Preventive medicine</topic><topic>Prophylaxis</topic><topic>Psychiatry</topic><topic>Psychotropic drugs</topic><topic>Quetiapine</topic><topic>Reviews</topic><topic>Salts</topic><topic>Systematic review</topic><topic>Tricyclic antidepressants</topic><topic>Valproic acid</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baldessarini, Ross J.</creatorcontrib><creatorcontrib>Tondo, Leonardo</creatorcontrib><creatorcontrib>Vázquez, Gustavo H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Molecular psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baldessarini, Ross J.</au><au>Tondo, Leonardo</au><au>Vázquez, Gustavo H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pharmacological treatment of adult bipolar disorder</atitle><jtitle>Molecular psychiatry</jtitle><stitle>Mol Psychiatry</stitle><addtitle>Mol Psychiatry</addtitle><date>2019-02-01</date><risdate>2019</risdate><volume>24</volume><issue>2</issue><spage>198</spage><epage>217</epage><pages>198-217</pages><issn>1359-4184</issn><eissn>1476-5578</eissn><abstract>We summarize evidence supporting contemporary pharmacological treatment of phases of BD, including: mania, depression, and long-term recurrences, emphasizing findings from randomized, controlled trials (RCTs). Effective treatment of acute or dysphoric mania is provided by modern antipsychotics, some anticonvulsants (divalproex and carbamazepine), and lithium salts. Treatment of BD-depression remains unsatisfactory but includes some modern antipsychotics (particularly lurasidone, olanzapine + fluoxetine, and quetiapine) and the anticonvulsant lamotrigine; value and safety of antidepressants remain controversial. Long-term prophylactic treatment relies on lithium, off-label use of valproate, and growing use of modern antipsychotics. Lithium has unique evidence of antisuicide effects. Methods of evaluating treatments for BD rely heavily on meta-analysis, which is convenient but with important limitations. Underdeveloped treatment for BD-depression may reflect an assumption that effects of antidepressants are similar in BD as in unipolar major depressive disorder. Effective prophylaxis of BD is limited by the efficacy of available treatments and incomplete adherence owing to adverse effects, costs, and lack of ongoing symptoms. Long-term treatment of BD also is limited by access to, and support of expert, comprehensive clinical programs. Pursuit of improved, rationally designed pharmacological treatments for BD, as for most psychiatric disorders, is fundamentally limited by lack of coherent pathophysiology or etiology.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>29679069</pmid><doi>10.1038/s41380-018-0044-2</doi><tpages>20</tpages></addata></record> |
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subjects | 692/699/476/1333 692/699/476/1414 Adult Adults Affective disorders Anticonvulsants Antidepressants Antidepressive Agents - therapeutic use Antimanic Agents - therapeutic use Antipsychotic agents Antipsychotic Agents - therapeutic use Antipsychotics Behavioral Sciences Biological Psychology Bipolar disorder Bipolar Disorder - drug therapy Bipolar Disorder - metabolism Carbamazepine Care and treatment Clinical trials Depressive Disorder, Major - drug therapy Dosage and administration Drug therapy Etiology Etiology (Medicine) Expert Review Fluoxetine Humans Lamotrigine Lithium Lithium - therapeutic use Lithium compounds Lithium Compounds - therapeutic use Major depressive disorder Mania Medicine Medicine & Public Health Mental depression Mental disorders Neurosciences Olanzapine Pharmacotherapy Preventive medicine Prophylaxis Psychiatry Psychotropic drugs Quetiapine Reviews Salts Systematic review Tricyclic antidepressants Valproic acid |
title | Pharmacological treatment of adult bipolar disorder |
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