Trends in the psychopharmacological treatment of bipolar disorder: a nationwide register-based study

2015 ◽  
Vol 28 (2) ◽  
pp. 75-84 ◽  
Author(s):  
Louise Bjørklund ◽  
Henriette Thisted Horsdal ◽  
Ole Mors ◽  
Søren Dinesen Østergaard ◽  
Christiane Gasse
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Tricyclic Antidepressants ◽  
Treatment Guidelines ◽  
Treatment Patterns ◽  
Central Research ◽  
Cross Sectional ◽  
Psychopharmacological Treatment ◽  
Research Register ◽  
Disorder Treatment

ObjectiveIn bipolar disorder, treatment with antidepressants without concomitant use of mood stabilisers (antidepressant monotherapy) is associated with development of mania and rapid cycling and is therefore not recommended. The present study aimed to investigate the psychopharmacological treatment patterns in bipolar disorder over time, with a focus on antidepressant monotherapy.MethodsCohort study with annual cross-sectional assessment of the use of psychotropic medications between 1995 and 2012 for all Danish residents aged 10 years or older with a diagnosis of bipolar disorder registered in the Danish Psychiatric Central Research Register. Users of a given psychotropic medication were defined as individuals having filled at least one prescription for that particular medication in the year of interest.ResultsWe identified 20 618 individuals with bipolar disorder. The proportion of patients with bipolar disorder using antidepressants, atypical antipsychotics and anticonvulsants increased over the study period, while the proportion of patients using lithium, typical antipsychotics and benzodiazepines/sedatives decreased. The proportion of patients treated with antidepressant monotherapy decreased from 20.5% in 1997 to 12.1% in 2012, and among antidepressant users, the proportion in monotherapy decreased from 47.7% to 23.9%, primarily driven by a decrease in the use of tricyclic antidepressants.ConclusionThe results show an increase in the proportion of patients with bipolar disorder being treated with antidepressants in the period from 1997 to 2012. However, in accordance with international treatment guidelines, the extent of antidepressant monotherapy decreased during the same period.

Typical and atypical antipsychotics in bipolar disorder

2000 ◽  
Vol 12 (3) ◽  
pp. 115-119 ◽  
Author(s):  
R.W. Licht
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Treatment Guidelines ◽  
Bipolar Depression ◽  
Term Treatment ◽  
Advantages And Disadvantages ◽  
Long Term Treatment ◽  
Randomised Controlled ◽  
Typical Antipsychotics

ABSTRACTBackground: In clinical practice, typical antipsychotics are widely used in the treatment of bipolar disorder, albeit in treatment guidelines often considered as adjunctive agents only. Recently, focus has shifted towards the use of atypical antipsychotics. This paper reviews the advantages and disadvantages associated with the use of antipsychotics in bipolar disorder.Methods: Randomised controlled trials (RCTs) were selected for review. A few review articles were also cited.Results: Typical antipsychotics, at least some of them, are powerful antimanics, beneficial for severe agitation in particular. However, in the long term treatment, typical antipsychics may precipitate depression. Among the atypical antipsychotics, both risperidone and olanzapine are clearly antimanic alternatives, although olanzapine is the best studied. Clozapine seems to be useful when other treatments fail to work.Conclusions: Antipsychotics are beneficial for some clinical presentations of mania. To minimize side effets, atypical agents should be preferred before typical agents, unless parenteral administration is needed. Despite the lack of RCTs, antipsychotics also seem to be useful as adjunctive agents in the treatment of psychotic bipolar depression. For the long term treatment of bipolar disorder, typical antipsychotics should be used only under certain circumstances. The place of atypical antipsychotics in the long term treatment of bipolar disorder remains to be studied.

Staging and neuroprogression in bipolar disorder: treatment implications

2017 ◽  
Author(s):  
Ives Cavalcante Passos ◽  
Flávio Kapczinski
Keyword(s):  
Bipolar Disorder ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Behaviour Therapy ◽  
Brain Circuits ◽  
Cognitive Behaviour ◽  
Disorder Treatment ◽  
Clinical Questions ◽  
The Brain ◽  
Progressive Course

It is known that if, not all, a substantial proportion of patients with bipolar disorder (BD) present a progressive course with functional and cognitive impairment. In addition, patients with BD and multiple mood episodes have a worse response to lithium and cognitive behaviour therapy. However, many current treatment guidelines do not take these clinical features that change with illness progression into account. In order to clarify these clinical questions, the term ‘neuroprogression’ was conceptualized as the pathological rewiring of the brain that takes place in parallel with the clinical deterioration in the course of BD. It provides a heuristic basis for conceptualizing the biochemical foundation of changes in brain circuits related to the progressive course of BD. Herein, we aim to review risk factors, biological underpinnings, and treatment implications related to neuroprogression in BD.

Clinical Research Evidence for the Use of Antipsychotics

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
E. Vieta
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Research Evidence ◽  
Treatment Guidelines ◽  
Adjunctive Treatment ◽  
Double Blind Study ◽  
Double Blind ◽  
Short And Long Term ◽  
Manic Patients

The use of atypical antipsychotics in the treatment of mania has become standard practice as supported by most currently available treatment guidelines. Aripiprazole, asenapine, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone have shown efficacy in placebo-controlled studies in acute mania. Not all these compounds, though, have been tested in maintenance therapy. Aripiprazole, for example, has been evaluated in numerous clinical trials in patients with bipolar disorder. Its efficacy was first established in two 3-week, placebo-controlled trials, and data are now available from a double-blind study of 100 weeks’ duration in manic patients, demonstrating both the effective stabilisation offered by aripiprazole and its superiority over placebo in preventing bipolar recurrence, primarily in preventing recurrence into mania.Furthermore, the addition of aripiprazole to lithium or valproate in patients who are partially non-responsive to these latter agents, can lead to significant improvement in mania symptoms. Several other atypical antipsychotics have also demonstrated adjunctive efficacy in patients with bipolar disorder, including olanzapine, quetiapine and risperidone. Studies comparing different atypical agents have generally shown that efficacy is similar, although the side effect and tolerability profiles differ between agents.In conclusion, atypical antipsychotics such as aripiprazole have proven short-and long-term efficacy as monotherapy or adjunctive treatment for bipolar mania, providing physicians with additional options when selecting the best treatment for their patients.

scholarly journals Psychiatric morbidity preceding psychotic and non-psychotic depression

2011 ◽  
Vol 26 (S2) ◽  
pp. 670-670
Author(s):  
S.D. Østergaard ◽  
P.T. Dinesen ◽  
G. Petrides ◽  
S. Skadhede ◽  
P. Munk-Jørgensen ◽  
...  
Keyword(s):  
Psychiatric Morbidity ◽  
Severe Depression ◽  
Psychotic Symptoms ◽  
Psychiatric Diagnoses ◽  
Central Research ◽  
Psychotic Depression ◽  
Psychopharmacological Treatment ◽  
Research Register ◽  
Icd 10 ◽  
History Of

IntroductionPsychotic depression differs significantly from non-psychotic depression in many aspects. These differences comprise etiology, severity, treatment response and prognosis.Objectives/aimsThe aim of the study was to assess the diversity of the psychiatric morbidity preceding psychotic and non-psychotic depression.MethodsDanish, register-based, nationwide cohort study. Subjects were all Danish residents assigned with an ICD-10 diagnosis of severe depression with- (F32.3 and F33.3) or without (F32.2 and F33.2) psychotic symptoms between January 1st 1994 and December 31st 2007. Psychiatric diagnoses preceding the severe depression were assessed through the Danish Psychiatric Central Research Register. It was investigated whether patients with psychotic depression had a history of more diverse/severe psychiatric morbidity and a different use of psychopharmacological drugs prior to index, compared to their non-psychotic counterparts.ResultsThe study included 29,254 subjects with severe depression. Of these, 9,768 patients (33%) were of the psychotic subtype while 19,576 (67%) were non-psychotic.Patients with the psychotic depressive subtype had a psychiatric history involving more and longer admission, more diverse diagnoses and a different pattern of psychopharmacological treatment compared to their non-psychotic counterparts. The results indicate, that psychotic depression may be more related to the bipolar/schizophrenia/psychosis spectrum than to the depression/anxiety spectrum.ConclusionsThe results add to a growing body of literature proving fundamental differences between psychotic- and non-psychotic severe depression. This should be considered in the upcoming revisions of the current diagnostic classifications.

scholarly journals Pharmacogenetic profile and major depressive and/or bipolar disorder treatment: a retrospective, cross-sectional study

2018 ◽  
Vol 19 (15) ◽  
pp. 1169-1179 ◽  
Author(s):  
Theresa R Tonozzi ◽  
Glenn D Braunstein ◽  
Anja Kammesheidt ◽  
Chris Curran ◽  
Shahrokh Golshan ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Major Depressive ◽  
Cross Sectional ◽  
Disorder Treatment

Metabolic Syndrome in Patients with Bipolar Disorder Treated with Atypical Antipsychotics, their First-degree Relatives and Control Group

2017 ◽  
Vol 41 (S1) ◽  
pp. S112-S112 ◽  
Author(s):  
S. Arya ◽  
H. Ahmadkhaniha ◽  
B. Arya
Keyword(s):  
Metabolic Syndrome ◽  
Bipolar Disorder ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Healthy Subjects ◽  
Atypical Antipsychotics ◽  
Normal Population ◽  
Control Group ◽  
Cross Sectional ◽  
First Degree Relatives

Introduction and objectivePatients with serious mental illness have lower life expectancy and higher prevalence of metabolic syndrome compared to normal population. Although, we have little evidence about their first-degree relatives.AimsTo compare metabolic syndrome in patients with bipolar disorder treated with atypical antipsychotics, their first degree relatives and healthy subjects in two age groups: under and over 40.MethodsThis cross-sectional study was conducted on 100 patients with bipolar disorder treated with atypical antipsychotics, 50 first degree relatives and 135 healthy subjects. The prevalence of metabolic syndrome was assessed based on National Cholesterol Education Program (NCEP).ResultsUnder the age of 40, the prevalence of metabolic syndrome was 15.4% in patients with Bipolar disorder, 17.6% in first degree relatives and 7% in healthy subjects. Systolic blood pressure was significantly higher in bipolar disorder patients (P = 0.004). In those over 40, the prevalence of metabolic syndrome was 31.8% in patients with bipolar disorder, 33.3% in first-degree relatives and 32.8% in healthy subjects. Serum levels of HDL were significantly lower in bipolar disorder patients (P = 0.002).ConclusionPatients with bipolar disorder and their first-degree relatives have greater chance for cardiovascular disease due to higher metabolic syndrome. Further investigations are needed for evaluating serious mental illness patients and their relatives.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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