Lithium Plus Olanzapine: One of the Most Effective Combinations for Bipolar Disorder. A Case Report and a Concise Review of the Literature

2021 ◽  
Vol 18 ◽  
Author(s):  
Aitzol Miguélez Rodríguez ◽  
Xabier Pérez de Mendiola Etxezarraga
Keyword(s):  
Bipolar Disorder ◽  
Scientific Literature ◽  
Maintenance Phase ◽  
Mood Stabilizers ◽  
Review Of The Literature ◽  
Case Presentation ◽  
Concise Review ◽  
Second Generation Antipsychotics ◽  
Psychotic Features ◽  
Recurrent Nature

Background: The recurrent nature of Bipolar Disorder (BD) is the main cause of disability associated with the illness. Despite the proliferation of drugs approved for the maintenance phase of BD, the relapse rate is still high. The combination of drugs, especially the potentiation of mood-stabilizers with second-generation antipsychotics, may reduce the risk of relapse and rehospitalization. However, studies on the efficacy of specific combinations are scarce. Case presentation: The clinical case of a 28-year-old woman involuntarily admitted to an Acute Psychiatric Unit is presented. She suffers a manic postpartum episode with mixed and psychotic features. During the hospitalization, she is successfully treated with a combination of lithium plus olanzapine. In the discussion, a concise narrative review of the scientific literature on the efficacy of such a combination in BD is made. Conclusion: The association of lithium plus olanzapine is one of the combinations with most evidence on its efficacy in BD, especially in mixed-featured episodes. Tolerability concerns should not be an obstacle to its use, although they must be considered

Is bipolar over diagnosed in adolescents?

2017 ◽  
Vol 41 (S1) ◽  
pp. S451-S451
Author(s):  
S. Paulino ◽  
N. Santos ◽  
A.C. Almeida ◽  
J. Gonçalves
Keyword(s):  
Systematic Review ◽  
Bipolar Disorder ◽  
Statistical Analysis ◽  
Mood Stabilizers ◽  
Review Of The Literature ◽  
Mood Instability ◽  
Adolescent Population ◽  
Life Threatening ◽  
Competing Interest

IntroductionSince the mid-1990s, the diagnosis of bipolar disorder has increased significantly: two-fold among adults, four-fold among adolescents and 40-fold among children. Mood instability is a hallmark symptom of many psychiatric disorders but does not imply necessarily a diagnosis of bipolar disorder. Misdiagnosis is not just an academic issue: mood stabilizers have significant adverse effects and expose patients to side effects that range from mild to potentially life-threatening.ObjectivesDiscuss the potential overestimation of bipolar diagnosis in the adolescent population through a statistical analysis of a sample from the adolescence's consultation of Centro Hospitalar Lisboa Norte.MethodsAnalysis of 106 patients taking into account the initial diagnosis and the diagnostic stability over 6 months. Non-systematic review of the literature.ResultsFrom this sample, 39.2% of the adolescents have a diagnose of unipolar affective disorder, 0.02% of bipolar disorder and 0.1% of disruptive mood disorder. These diagnoses did not change over the follow-up period.ConclusionIt is important to try to understand the reasons of this potential discrepancy (influence of pharmaceutical company marketing, of parents’ desire, of doctors’ fear) to reduce controversy and confusion and to adjust treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Mood Stabilizers: Implementing Combined Treatment Regimens in Bipolar Disorder

2018 ◽  
Author(s):  
Charles Bowden ◽  
Melissa Martinez
Keyword(s):  
Bipolar Disorder ◽  
Treatment Planning ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Combined Treatment ◽  
Bipolar Disorders ◽  
Maintenance Phase ◽  
Mood Stabilizers ◽  
Outcome Analysis ◽  
Treatment Regimens

Patients with bipolar disorders spend a greater proportion of their illness in a depressed or mixed state rather than experiencing either mania or hypomania. Over the past 20 years, most major pharmaceutical companies have either reduced or abandoned the research and development of novel psychiatric drugs, exiting the development of new, safe, efficacious, and tolerable treatment regimens for bipolar disorder. Therefore, optimizing the current treatments available is critical. We review studies of the last 15 years that provide guidance relevant to managing the maintenance phase of bipolar disorders. Based on these data, we provide recommendations for effective treatment planning and implementation, principally for the maintenance phase care of persons with bipolar disorder. We also discuss strategies for implementing medication regimens, differentiating strategies for maintenance phase treatment from those of acute phase treatment. Assessing key symptoms that are sensitive to change is critical for longitudinal assessments and treatment planning for patients with bipolar disorders. In most studies, only a subset of rating scale items differentiate patients with good responses from those without. Identified symptoms include racing thoughts, less need for sleep, hyperactivity, increased activity, and increased energy. We developed a procedure for using Multistate Outcome Analysis of Treatment (MOAT) in bipolar disorders. MOAT integrates efficacy and tolerability data during studies to provide information about the quantity and quality of time spent in distinct mood states. The protocol developed will be useful for assessing treatment strategies in bipolar disorder. This review contains 4 figures, 7 tables and 32 references Key words: bipolar, depression, lithium, mania, mixed, mood stabilizer, survival analysis, symptom domains, valproate

scholarly journals Mood stabilizers and/or antipsychotics for bipolar disorder in the maintenance phase: a systematic review and network meta-analysis of randomized controlled trials

2020 ◽  
Author(s):  
Taro Kishi ◽  
Toshikazu Ikuta ◽  
Yuki Matsuda ◽  
Kenji Sakuma ◽  
Makoto Okuya ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Maintenance Phase ◽  
Credible Interval ◽  
Mood Stabilizers ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Long Acting ◽  
Meta Analyses

Abstract We searched Embase, PubMed, and CENTRAL from inception until 22 May 2020 to investigate which antipsychotics and/or mood stabilizers are better for patients with bipolar disorder in the maintenance phase. We performed two categorical network meta-analyses. The first included monotherapy studies and studies in which the two drugs used were specified (i.e., aripiprazole, aripiprazole once monthly, aripiprazole+lamotrigine, aripiprazole+valproate, asenapine, carbamazepine, lamotrigine, lamotrigine+valproate, lithium, lithium+oxcarbazepine, lithium+valproate, olanzapine, paliperidone, quetiapine, risperidone long-acting injection, valproate, and placebo). The second included studies on second-generation antipsychotic combination therapies (SGAs) (i.e., aripiprazole, lurasidone, olanzapine, quetiapine, and ziprasidone) with lithium or valproate (LIT/VAL) compared with placebo with LIT/VAL. Outcomes were recurrence/relapse rate of any mood episode (RR-any, primary), depressive episode (RR-dep) and manic/hypomanic/mixed episode (RR-mania), discontinuation, mortality, and individual adverse events. Risk ratios and 95% credible interval were calculated. Forty-one randomized controlled trials were identified (n = 9821; mean study duration, 70.5 ± 36.6 weeks; percent female, 54.1%; mean age, 40.7 years). All active treatments other than carbamazepine, lamotrigine+valproate (no data) and paliperidone outperformed the placebo for RR-any. Aripiprazole+valproate, lamotrigine, lamotrigine+valproate, lithium, olanzapine, and quetiapine outperformed placebo for RR-dep. All active treatments, other than aripiprazole+valproate, carbamazepine, lamotrigine, and lamotrigine+valproate, outperformed placebo for RR-mania. Asenapine, lithium, olanzapine, quetiapine, and valproate outperformed placebo for all-cause discontinuation. All SGAs+LIT/VALs other than olanzapine+LIT/VAL outperformed placebo+LIT/VAL for RR-any. Lurasidone+LIT/VAL and quetiapine+LIT/VAL outperformed placebo+LIT/VAL for RR-dep. Aripiprazole+LIT/VAL and quetiapine+LIT/VAL outperformed placebo+LIT/VAL for RR-mania. Lurasidone+LIT/VAL and quetiapine+LIT/VAL outperformed placebo+LIT/VAL for all-cause discontinuation. Treatment efficacy, tolerability, and safety profiles differed among treatments.

Drug Class Summaries and Dosing Guidelines

2018 ◽  
pp. 158-165
Author(s):  
S. Nassir Ghaemi
Keyword(s):  
Bipolar Disorder ◽  
Side Effects ◽  
Mood Stabilizer ◽  
Mood Stabilizers ◽  
Bipolar Illness ◽  
Drug Classes ◽  
Second Generation Antipsychotics ◽  
Reasonable Evidence ◽  
Depressive Episodes ◽  
Major Drug

A “mood stabilizer” is a drug that prevents mania and depressive episodes in bipolar disorder. The four drugs that have reasonable evidence that they can do this are lithium, Depakote, carbamazepine, and Lamictal. Second generation antipsychotics are not mood stabilizers, despite the FDA maintenance indications that many have received, because of the invalidity of the enriched, randomized, discontinuation maintenance design. Thus, all patients with bipolar illness should receive one of those four mood stabilizers, and dopamine blockers should be used as adjuncts, but not by themselves. In this chapter, a summary is given of the major drug classes, and the agents within those classes. Specific dosing guidelines are provided for most agents. Main clinical side effects and drug interactions are reviewed.

Evidence-based maintenance treatment of bipolar disorder

2017 ◽  
Author(s):  
Dina Popovic ◽  
Eduard Vieta
Keyword(s):  
Bipolar Disorder ◽  
Randomized Controlled Trials ◽  
Maintenance Treatment ◽  
Mood Stabilizers ◽  
Controlled Trials ◽  
Pharmacological Treatments ◽  
Randomized Controlled ◽  
Second Generation Antipsychotics ◽  
Long Acting

Due to the episodic and chronic nature of bipolar disorder, maintenance therapy represents a critical part of treatment. However, there is a paucity of studies comparing effectiveness of available long-term treatments. In this chapter, the efficacy and safety of pharmacological treatments for maintenance treatment of bipolar disorder, as deriving from the results of randomized controlled trials, will be critically reviewed. These include second-generation antipsychotics aripiprazole, olanzapine, quetiapine, risperidone long-acting injection, ziprasidone, paliperidone, and mood stabilizers lamotrigine, lithium, valproate, carbamazepine, and oxcarbazepine. In general, if a patient has responded satisfactorily to a certain drug during the acute phase, the same treatment should be maintained during maintenance treatment. This was confirmed in two randomized controlled trials. This chapter summarizes the characteristics of the placebo-controlled randomized controlled trials for all the antipsychotics used for maintenance treatment of bipolar disorder.

Treatments for Pediatric Bipolar Disorder

2015 ◽  
Author(s):  
Pablo H. Goldberg ◽  
Prerna Martin ◽  
Carolina Biernacki ◽  
Moira A. Rynn
Keyword(s):  
Bipolar Disorder ◽  
Mood Stabilizer ◽  
Psychosocial Interventions ◽  
Mood Stabilizers ◽  
Pediatric Bipolar Disorder ◽  
Careful Monitoring ◽  
The Past ◽  
Second Generation Antipsychotics ◽  
Evidence Based Treatments

The past two decades have seen significant advances in the development of evidence-based treatments for pediatric bipolar disorder. Practice guidelines recommend pharmacotherapy with mood stabilizers or second-generation antipsychotics (SGAs) as the first-line treatment. Lithium, risperidone, aripiprazole, quetiapine, and olanzapine are approved by the U.S. Food & Drug Administration for treating bipolar disorder in children and adolescents. The pharmacological literature suggests that SGAs are faster and more effective than mood stabilizers in treating acute manic or mixed episodes, but they have significant side effects and require careful monitoring. While mild to moderate bipolar disorder can be treated with monotherapy, combination pharmacotherapy with an SGA and a mood stabilizer is recommended for youth with severe bipolar disorder. A growing body of literature also suggests the efficacy of psychosocial interventions, with family psychoeducation and skills building as adjunct treatments to pharmacotherapy. More type 1 studies of pharmacotherapy and psychosocial treatments are needed.

Use of antidepressants in maintenance phase of patients with bipolar disorder in an outpatient setting

2016 ◽  
Vol 33 (S1) ◽  
pp. S124-S124
Author(s):  
A. Peh ◽  
W.K. Tay
Keyword(s):  
Bipolar Disorder ◽  
Combination Treatment ◽  
Maintenance Treatment ◽  
Maintenance Phase ◽  
Outpatient Setting ◽  
Mood Stabilizers ◽  
Psychiatric Clinic ◽  
Bipolar Ii ◽  
Antidepressant Use ◽  
Competing Interest

IntroductionGuidelines for the maintenance treatment of bipolar disorder discourage the use of antidepressants chiefly on grounds of unproven efficacy and risk if mania for bipolar I. However, for patients stabilised on an antidepressant, naturalistic data support its continued use.AimThe aim is to describe use of antidepressants in patients with bipolar disorder in remission seen at an outpatient clinic in Singapore.MethodsThe case notes of patients with bipolar disorder in remission, seen by psychiatrist in an outpatient psychiatric clinic in a general hospital unit from December 2014 to March 2015 were studied. Data describing the age, sex, type of bipolar disorder and psychotropic medications prescribed, was obtained.ResultsForty-two patients were included, of which 13 (31%) were male and 29 (69%) were female. The age ranged from 23 to 82, with mean age of 47 years. Of these 17 (40%) had bipolar I and 25 (60%) had bipolar II. Antidepressant use for maintenance treatment was present in 19 out of 42 (45%) of these patients; of these 7 out of 17 (41%) were bipolar 1 and 12 out of 25 (48%) were bipolar II. Eighteen out of the 19 (95%) patients who were prescribed antidepressants were on combination treatment with mood stabilizers. Antidepressant type included SSRI (37%), NDRI (37%), SNRI (10.5%), TCA (10.5%), NASSA (5%).ConclusionAlmost half of patients with bipolar disorder managed in an individual practice were on antidepressants together with mood stabilisers. They remained in remission with combination treatment, which did not seem to jeopardise their condition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals “SLURRED SPEECH AND TREMORS RESULTING FROM ANTIPSYCHOTIC THERAPY IN A PATIENT WITH BIPOLAR DISORDER: A CASE REPORT”

2021 ◽  
pp. 1-2
Author(s):  
SOMANABOINA PADMAKAR
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Mood Disorder ◽  
Psychiatric Hospitalization ◽  
Mood Stabilizers ◽  
Activity Levels ◽  
First Line ◽  
Antipsychotic Therapy ◽  
Second Generation Antipsychotics ◽  
A Minor

Bipolar disorder (BD) is a mood disorder where moods can fluctuate from depression to elevated moods referred to as mania. BD is currently divided into three types. All three types involve clear changes in mood, energy, and activity levels. BD-I is the most severe disorder and symptoms of mania can be so severe that they can require psychiatric hospitalization. BD-II has the same symptoms as BD-I; however, it was described as hypomania because they are less severe than in pure mania. Cyclothymia, also known as a cyclothymic disorder, is a minor mood disorder characterized by fluctuating low-level depressive symptoms and periods of mild mania, similar to BD-II. Mood stabilizers and second-generation antipsychotics are first-line for treating and maintaining a stable mood. This study related to a case report on slurred speech and tremors induced by antipsychotics in a patient suffering from BD.

scholarly journals Trends in Prescriptions of Lithium and Other Medications for Patients with Bipolar Disorder in Office-based Practices in the United States: 1996-2015

2020 ◽  
Author(s):  
Yian Lin ◽  
Ramin Mojtabai ◽  
Fernando S Goes ◽  
Peter P Zandi
Keyword(s):  
United States ◽  
Bipolar Disorder ◽  
The United States ◽  
Mood Stabilizers ◽  
First Line Therapy ◽  
Second Generation Antipsychotics ◽  
Prescribing Trends ◽  
Care Survey ◽  
Limited Power ◽  
Ambulatory Medical Care

AbstractBackgroundStudies have shown that rates of lithium use for bipolar disorder (BPD) in the United States declined through the 1990s as other mood stabilizing anticonvulsants and second-generation antipsychotics (SGAs) became more popular. We examined recent prescribing trends of medications for BPD over the past two decades.MethodsTwenty years of data (1996-2015) from the National Ambulatory Medical Care Survey (NAMCS) were used. Weighted percentages of prescriptions of lithium, anticonvulsants, SGAs and antidepressants were calculated over two-year intervals. Logistic regression was used to examine factors related to polytherapy.ResultsPrescriptions of lithium declined from 38.1% (95%CI: 29.8% - 46.3%) in 1996-97 to 14.3% (95%CI: 10.6% - 18.1%) in 2006-07 and has remained stable since. During this time, prescriptions of SGAs more than doubled. SGAs and/or anticonvulsants were prescribed in 78.6% (95%CI: 73.0% - 84.2%) of BPD visits in 2014-2015. Polytherapy increased by approximately 4% every two years and in 2014-15 occurred in over 35% of BPD visits. Antidepressants were prescribed in 40-50% of BPD visits, but their prescriptions without other mood stabilizers decreased from 18.2% (95%CI: 11.7% - 24.8%) in 1998-99 to 5.8% (95%CI: 3.0% - 8.6%) in 2014-15.LimitationsThe sample had limited power to study the effect of individual medications or the potential for differing effects in certain subgroups of patients.ConclusionsThis study further documents the declining prescriptions of lithium for BPD, and corresponding increase in prescriptions of anticonvulsants and SGAs, despite the fact that lithium is typically recommended as a first line therapy for BPD.

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