scholarly journals Treatment of Acute and Maintenance Phase of Bipolar Depression

2021 ◽  
Author(s):  
Evrim Erten
Keyword(s):  
Bipolar Depression ◽  
Maintenance Phase

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 The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder

2019 ◽  
Vol 23 (4) ◽  
pp. 230-256 ◽  
Author(s):  
Konstantinos N Fountoulakis ◽  
Lakshmi N Yatham ◽  
Heinz Grunze ◽  
Eduard Vieta ◽  
Allan H Young ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Treatment Options ◽  
Treatment Resistance ◽  
Maintenance Phase ◽  
Evidence Based ◽  
Treatment Resistant ◽  
Evidence Based Treatment ◽  
Significant Disability ◽  
Definition Of

Abstract Background Resistant bipolar disorder is a major mental health problem related to significant disability and overall cost. The aim of the current study was to perform a systematic review of the literature concerning (1) the definition of treatment resistance in bipolar disorder, (2) its clinical and (3) neurobiological correlates, and (4) the evidence-based treatment options for treatment-resistant bipolar disorder and for eventually developing guidelines for the treatment of this condition Materials and Methods The PRISMA method was used to identify all published papers relevant to the definition of treatment resistance in bipolar disorder and the associated evidence-based treatment options. The MEDLINE was searched to April 22, 2018. Results Criteria were developed for the identification of resistance in bipolar disorder concerning all phases. The search of the literature identified all published studies concerning treatment options. The data were classified according to strength, and separate guidelines regarding resistant acute mania, acute bipolar depression, and the maintenance phase were developed. Discussion The definition of resistance in bipolar disorder is by itself difficult due to the complexity of the clinical picture, course, and treatment options. The current guidelines are the first, to our knowledge, developed specifically for the treatment of resistant bipolar disorder patients, and they also include an operationalized definition of treatment resistance. They were based on a thorough and deep search of the literature and utilize as much as possible an evidence-based approach.

Monotherapy vs combination therapy in bipolar disorder: What does the evidence say?

2011 ◽  
Vol 26 (S2) ◽  
pp. 2026-2026
Author(s):  
K. Fountoulakis
Keyword(s):  
Bipolar Disorder ◽  
Combination Therapy ◽  
Combination Treatment ◽  
Bipolar Depression ◽  
Maintenance Phase ◽  
Mood Stabilizer ◽  
Inadequate Response ◽  
Manic Depressive ◽  
Combination Studies ◽  
Manic Patients

The treatment of bipolar disorder is complex and the overall results of monotherapy are not satisfactory. Combination and add-on studies suggest that in acutely manic patients who are partial responders to lithium, valproate or carbamazepine, a good strategy would be to add haloperidol, risperidone, olanzapine, quetiapine or aripiprazole. Adding oxcarbazepine to lithium is also a choice. For patients with refractory bipolar depression the only positive data concern adding lamotrigine to lithium. During the maintenance phase the combination of quetiapine plus mood stabilizer is superior to monotherapy in the prevention of manic and depressive recurrences in either manic, depressive, or mixed index episode over a period of 2-years. These combination studies appear to be the first to report prevention on both depression and mania regardless of the type of index episode.Discontinuation studies suggest that patients stabilized on combination therapy (olanzapine plus lithium/valproate or mood stabilizer plus ziprasidone) do worse when the antipsychotic is discontinued. The recently published BALANCE could neither reliably confirm nor refute a benefit of combination therapy compared with lithium monotherapy. Add on studies suggest that at least some strategies could be useful in patients with inadequate response to monotherapy. Overall, although there is no compelling data that combination treatment does better than monotherapy, the data suggest that those patients stabilized on combination treatment might do worse if shifted from combination, and patients refractory to monotherapy could benefit with add on treatment with olanzapine, valproate, an antidepressant or lamotrigine, depending on the index acute phase.

The PREVIEW Study

2019 ◽  
Vol 26 (1) ◽  
pp. 10-20
Author(s):  
Maija Huttunen-Lenz ◽  
Sylvia Hansen ◽  
Thomas Meinert Larsen ◽  
Pia Christensen ◽  
Mathijs Drummen ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Maintenance ◽  
Maintenance Phase ◽  
Habit Strength ◽  
Health Habits ◽  
Cross Sectional ◽  
Socio Economic Variables ◽  
Overweight Adults ◽  
Modification Intervention

Abstract. Individuals at risk of Type 2 Diabetes are advised to change health habits. This study investigated how the PREMIT behavior modification intervention and its association with socio-economic variables influenced weight maintenance and habit strength in the PREVIEW study. Overweight adults with pre-diabetes were enrolled ( n = 2,224) in a multi-center RCT including a 2-month weight-loss phase and a 34-month weight-maintenance phase for those who lost ≥ 8% body weight. Initial stages of the PREMIT covered the end of weight-loss and the beginning of weight-maintenance phase (18 weeks). Cross-sectional and longitudinal data were explored. Frequent PREMIT sessions attendance, being female, and lower habit strength for poor diet were associated with lower weight re-gain. Being older and not in employment were associated with lower habit strength for physical inactivity. The PREMIT appeared to support weight loss maintenance. Younger participants, males, and those in employment appeared to struggle more with inactivity habit change and weight maintenance.

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