Efficacy and Effectiveness of Lithium in the Long-Term Treatment of Bipolar Disorders: An Update 2018

2018 ◽  
Vol 51 (05) ◽  
pp. 173-176 ◽  
Author(s):  
Emanuel Severus ◽  
Michael Bauer ◽  
John Geddes
Keyword(s):  
Atypical Antipsychotic ◽  
Scientific Evidence ◽  
Bipolar Disorders ◽  
Manic Episode ◽  
Term Treatment ◽  
Individualized Care ◽  
Long Term Treatment ◽  
Continuation Treatment ◽  
New Research

AbstractFor more than 40 years, lithium has been the gold standard in the long-term treatment of bipolar disorders. In the course of the last 15 years, other drugs have been approved in this indication and are widely used in clinical practice at the expense of lithium. New research from the last few years, however, indicates that lithium is still the first-line treatment in this indication. Against this background and lithium’s proven acute antimanic efficacy, we should perhaps be using lithium more regularly (in combination with an atypical antipsychotic, if necessary) right from the start for the acute treatment of a manic episode and, once remission has been achieved and euthymia maintained during continuation treatment, to regularly taper off the atypical antipsychotic, if possible, and continue with lithium as monotherapy for prophylactic treatment. This might lead to lithium being used more consistently with the scientific evidence in the long-term treatment of bipolar disorders. It remains uncertain, however, to predict who will respond to and tolerate lithium prophylactically, and more research is needed to deliver the best possible individualized care to our patients.

scholarly journals Maintenance pharmacotherapy of unipolar depression

1999 ◽  
Vol 23 (6) ◽  
pp. 370-373 ◽  
Author(s):  
Som Forshall ◽  
David J. Nutt
Keyword(s):  
Prophylactic Treatment ◽  
Unipolar Depression ◽  
Term Treatment ◽  
Current Evidence ◽  
Full Remission ◽  
Long Term Treatment ◽  
Continuation Treatment ◽  
Term Maintenance ◽  
Review Current

Aims and methodsThe purpose of this paper is to review current evidence and opinion with regard to the long-term treatment of unipolar depression. The method employed was a Psychlit search using the search items long-term, maintenance, treatment and depression.ResultsThe search yielded 91 articles.Clinical implicationsUnipolar depression is frequently recurrent and sometimes a chronic illness. The paper identifies those at greatest risk of recurrence. It goes on to examine strategies to prevent relapse and for prophylactic treatment. It concludes that continuation treatment should be sustained at full dose for 4–6 months after full remission of symptoms. Where depression is highly recurrent the acute phase dose should be maintained in the long-term.

P01-32 - The effect of valproat versus lithium in the long-term treatment of subtypes of bipolar disorders (BD)

2010 ◽  
Vol 25 ◽  
pp. 252
Author(s):  
F. Elezi ◽  
E. Sotiri ◽  
A. Braho ◽  
F. Dobi ◽  
A. Dyrma ◽  
...  
Keyword(s):  
Bipolar Disorders ◽  
Term Treatment ◽  
Long Term Treatment

scholarly journals Administration of ziprasidone for 10 days increases cocaine toxicity in mice

2008 ◽  
Vol 27 (6) ◽  
pp. 499-503 ◽  
Author(s):  
K Heard ◽  
S Krier ◽  
NR Zahniser
Keyword(s):  
Atypical Antipsychotic ◽  
Term Treatment ◽  
Toxic Effects ◽  
Neurotransmitter Receptors ◽  
Control Group ◽  
Long Term Treatment ◽  
Significant Difference ◽  
Group Survival ◽  
Cocaine Toxicity

Long-term treatment with antipsychotic medications alters the regional density of several of the neurotransmitter receptors that mediate cocaine toxicity. However, the effect of either up- or down-regulation of the neurotransmitter receptors on cocaine toxicity is unknown. In this study, we determined if subacute administration of the atypical antipsychotic ziprasidone altered the toxic effects of cocaine in mice. Ziprasidone (4 mg/kg) or placebo was administered to the first two groups of CF-1 mice for 10 days and, then on day 10, an estimated LD50 dose of cocaine (102 mg/kg) was given to these mice. In a third group, in order to produce a ziprasidone withdrawal state, we administered ziprasidone for 10 days, followed by no treatment for 2 days before cocaine administration. There was no significant difference among the three groups in overall survival: 63% in the treatment group, 60% in the withdrawal group, and 80% in the placebo group. Survival time was significantly shorter for the withdrawal group than for the control group. Our study may have been limited by lower than expected serum ziprasidone concentrations and lower than expected lethality from cocaine. However, our findings suggest that administration of an atypical antipsychotic for 10 days may increase the toxic effects of cocaine.

scholarly journals A consensus guideline for antipsychotic drug use for dementia in care homes. Bridging the gap between scientific evidence and clinical practice

2015 ◽  
Vol 27 (11) ◽  
pp. 1849-1859 ◽  
Author(s):  
Sytse U. Zuidema ◽  
Alice Johansson ◽  
Geir Selbaek ◽  
Matt Murray ◽  
Alistair Burns ◽  
...  
Keyword(s):  
Los Angeles ◽  
Practice Guideline ◽  
Treatment Plan ◽  
Scientific Evidence ◽  
Term Treatment ◽  
Care Homes ◽  
Delphi Consensus ◽  
People With Dementia ◽  
Long Term Treatment

ABSTRACTBackground:To produce a practice guideline that includes a set of detailed consensus principles regarding the prescription of antipsychotics (APs) amongst people with dementia living in care homes.Methods:We used a modified Delphi consensus procedure with three rounds, where we actively specified and optimized statements throughout the process, utilizing input from four focus groups, carried out in UK, Norway, and the Netherlands. This was done to identify relevant themes and a set of statement that experts agreed upon using the Research and Development/University of California at Los Angeles (RAND/UCLA) methodology.Results:A total of 72 scientific and clinical experts and 14 consumer experts reached consensus upon 150 statements covering five themes: (1) General prescription stipulations, (2) assessments prior to prescription, (3) care and treatment plan, (4) discontinuation, and (5) long-term treatment.Conclusions:In this practice guideline, novel information was provided about detailed indication and thresholds of symptoms, risk factors, circumstances at which APs should be stopped or tapered, specific criteria for justifying long-term treatment, involvement of the multidisciplinary team, and family caregiver in the process of prescription. The practice guideline is based on formal consensus of clinicians and consumer experts and provides clinicians relevant practical information that is lacking in current guidelines.

Continuous circular cycling as a predictor of treatment response in bipolar disorders: a comprehensive review of the current literature

CNS Spectrums ◽  
2017 ◽  
Vol 23 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Antonio Tundo ◽  
Paola Cavalieri
Keyword(s):  
Bipolar Disorders ◽  
Poor Response ◽  
Term Treatment ◽  
Small Sample ◽  
Long Term Treatment ◽  
Group Members ◽  
Short And Long Term ◽  
Small Sample Sizes

Evidence from the literature suggests that, on average, 27% of patients with a bipolar disorder (BD) experience a continuous cycling course (CCC) and that this subgroup differs significantly from patients with a noncontinuous cycling course (N-CCC) with respect to sociodemographic characteristics and clinical presentation. The aim of the present paper is to review the studies that evaluated short- and long-term treatment responses in BD patients with CCC. The retrieved studies indicate that CCC is a significant predictor of poor response to long-term treatment with lithium (the odds of a response in the CCC group were 57% less than in the N-CCC group; p<0.01), as well as to polytherapies including lithium and/or an antiepileptic augmented, when necessary, with an antipsychotic and/or antidepressant. The percentage of patients without new episodes during follow-up was significantly lower in the CCC group compared with the N-CCC group (15.4 vs. 37.6% , p<0.01). Compared with patients in the N-CCC group, members of the CCC group had a poorer response and lower remission rates after 12-week antidepressant treatments for a major depressive episode (82.3 vs. 50%, p =0.002; 69.6 vs. 40.9%, p=0.013). These findings, underlining that CCC is a predictor of poor response to short- and long-term treatment in BD, should be interpreted considering the limitations of the reviewed studies (the small sample sizes, the small number of trials and their observational nature, the lack of randomization or placebo controls, and the unblinded nature of the outcomes). Clinical trials and observational studies with larger samples are warranted to confirm the conclusions of our review.

A Comparison Between Manic Patients With or Without Antipsychotic Continuation Treatment: Data from a 12-months Follow-up Study at Mood Disorder Unit of San Raffaele–Turro Hospital

2017 ◽  
Vol 41 (S1) ◽  
pp. S119-S120
Author(s):  
S. Brioschi ◽  
D. Delmonte ◽  
C. Locatelli ◽  
L. Franchini ◽  
B. Barbini ◽  
...  
Keyword(s):  
Mood Stabilizer ◽  
Manic Episode ◽  
Mood Stabilizers ◽  
Antipsychotic Therapy ◽  
Course Of Illness ◽  
Long Term Treatment ◽  
Continuation Treatment ◽  
Bipolar Patients

IntroductionSeveral studies suggest that in severe bipolars there is a long-term benefit in continuing antipsychotic therapy plus a mood stabilizer also after remission from a manic episode. Nevertheless, the long-term use of antipsychotics is associated with significant side effects which can interfere with patient global functioning. In this sense, antipsychotics should not be continued unless the benefits outweight the risks.ObjectivesThe present study describes the course of illness between bipolar patients remitted from a manic episode, in continuation treatment with or without antipsychotic therapy during a 12-months follow-up period.MethodsCinquante-six bipolars (22 male and 44 female) remitted (Young < 12) from a severe manic episode were observed during a 12-months follow-up. According to clinical judge, as continuation treatment, 21/56 (37.5%) took antipsychotic plus mood stabilizer (AP + MS); 35/56 (62.5%) took mood stabilizers monotherapy (MS). During follow-up period YMRS and HAM-D were administered at 6th and 12th month to verify remission.ResultsAt the end of follow-up up, 33/56 patients (58.9%) maintained remission, 23/56 (41.1%) relapsed (56.5% depressive, 31.4% manic). The greater number of relapses occurred within 6th month: 16/56 (28.8%). In AP + MS group 12/21 patients relapsed (57.14%); in MS group 11/35 patients relapsed (31.4%). No statistical difference between the two continuation treatment strategies was observed (Chi-square = 3.586; P = 0.06).ConclusionsOur data confirm the efficacy of mood stabilizers monotherapy in long-term treatment of our severe (psychotic features, revolving-doors) bipolar patients. In fact, once the remission was obtained, the clinical choice of discontinuing antipsychotic therapy did not worsen the course of illness without a higher risk of relapse.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Long-term treatment response to continuous cycling course in bipolar disorders: A meta-analysis.

2018 ◽  
Vol 241 ◽  
pp. 367-370
Author(s):  
Antonio Tundo ◽  
Franco De Crescenzo ◽  
Davide Gori ◽  
Paola Cavalieri
Keyword(s):  
Treatment Response ◽  
Meta Analysis ◽  
Bipolar Disorders ◽  
Term Treatment ◽  
Long Term Treatment ◽  
Continuous Cycling

Stabilization in the treatment of mania, depression and mixed states

2000 ◽  
Vol 12 (3) ◽  
pp. 110-114 ◽  
Author(s):  
D.J. Kupfer ◽  
E. Frank ◽  
V.J. Grochocinski ◽  
J.F. Luther ◽  
P.R. Houck ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Acute Phase ◽  
Treatment Strategies ◽  
Manic Episode ◽  
Term Treatment ◽  
Therapeutic Approaches ◽  
Mixed States ◽  
Long Term Treatment ◽  
Time To Stabilization

ABSTRACTWhile one major need for improved therapeutic approaches in bipolar disease is the development of long-term treatment strategies, a systematic approach during the acute phase of bipolar disorder is also required. In our own studies we have arbitrarily divided the initial treatment of subjects by the predominant polarity for which they are treated acutely: manic, depressed, or mixed/cycling.1 In this larger investigation of over 150 patients with bipolar disorder, we now demonstrated again that the time to initial stabilization is generally the shortest with a manic episode and the longest with a mixed/cycling episode with the depressed episode in the middle (although almost as long as the mixed/cycling episode). These findings indicate the difficulty of treating both the depressed phase and mixed/cycling episodes in bipolar disorder. It is also noteworthy that gender does not have a significant effect on time to stabilization. Such findings in the acute phase have profound implications in designing and carrying out long-term therapeutic strategies for this disorder.

scholarly journals Effects of Psychostimulants and Antipsychotics on Serum Lipids in an Animal Model for Schizophrenia

Biomedicines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 235
Author(s):  
Banny Silva Barbosa Correia ◽  
João Victor Nani ◽  
Raniery Waladares Ricardo ◽  
Danijela Stanisic ◽  
Tássia Brena Barroso Carneiro Costa ◽  
...  
Keyword(s):  
Animal Model ◽  
Lipid Metabolism ◽  
Atypical Antipsychotic ◽  
Serum Lipids ◽  
Spontaneously Hypertensive Rat ◽  
Term Treatment ◽  
First Episode ◽  
Omega 3 ◽  
Long Term Treatment

Schizophrenia (SCZ) treatment is essentially limited to the use of typical or atypical antipsychotic drugs, which suppress the main symptoms of this mental disorder. Metabolic syndrome is often reported in patients with SCZ under long-term drug treatment, but little is known about the alteration of lipid metabolism induced by antipsychotic use. In this study, we evaluated the blood serum lipids of a validated animal model for SCZ (Spontaneously Hypertensive Rat, SHR), and a normal control rat strain (Normotensive Wistar Rat, NWR), after long-term treatment (30 days) with typical haloperidol (HAL) or atypical clozapine (CLZ) antipsychotics. Moreover, psychostimulants, amphetamine (AMPH) or lisdexamfetamine (LSDX), were administered to NWR animals aiming to mimic the human first episode of psychosis, and the effects on serum lipids were also evaluated. Discrepancies in lipids between SHR and NWR animals, which included increased total lipids and decreased phospholipids in SHR compared with NWR, were similar to the differences previously reported for SCZ patients relative to healthy controls. Administration of psychostimulants in NWR decreased omega-3, which was also decreased in the first episode of psychosis of SCZ. Moreover, choline glycerophospholipids allowed us to distinguish the effects of CLZ in SHR. Thus, changes in the lipid metabolism in SHR seem to be reversed by the long-term treatment with the atypical antipsychotic CLZ, which was under the same condition described to reverse the SCZ-like endophenotypes of this validated animal model for SCZ. These data open new insights for understanding the potential influence of the treatment with typical or atypical antipsychotics on circulating lipids. This may represent an outcome effect from metabolic pathways that regulate lipids synthesis and breakdown, which may be reflecting a cell lipids dysfunction in SCZ.

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