Assessment of lithium-related knowledge and attitudes among patients with bipolar disorder on long-term lithium maintenance treatment

Bipolar disorder is a common and serious illness usually requiring long term medication. We critically review the available evidence surrounding the increasing use of quetiapine, a second generation antipsychotic, in both the acute and maintenance phases of bipolar disorder. Large scale, randomized controlled data supports the use of quetiapine in both acute mania and acute bipolar depression, as a safe and effective treatment and probably best used in combination with a traditional ‘mood stabiliser’ such as lithium or divalproex. Also, quetiapine monotherapy has been shown to be effective in bipolar depression. Two recently published studies also confirm that quetiapine in combination with either lithium or divalproex ‘adds value’ to the maintenance treatment of bipolar disorder in terms of delaying relapse compared to either lithium or divalproex alone. Quetiapine is generally well tolerated, although further work on long term weight gain and emergent diabetes would be helpful.

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Bupropion Maintenance Treatment in Refractory Bipolar Depression: A Case Report

Clinical Practice and Epidemiology in Mental Health ◽

10.2174/1745017901713010043 ◽

2017 ◽

Vol 13 (1) ◽

pp. 43-48

Author(s):

Julia Dehning ◽

Heinz Grunze ◽

Armand Hausmann

Keyword(s):

Bipolar Disorder ◽

Case Report ◽

Maintenance Treatment ◽

Bipolar Depression ◽

Antidepressant Treatment ◽

Mood Stabilizer ◽

Obvious Benefit ◽

Insufficient Response ◽

Bipolar Patients

Background:The optimal duration of antidepressant treatment in bipolar depression appears to be controversial due to a lack of quality evidence, and guideline recommendations are either vague or contradictive. This is especially true for second line treatments such as bupropion that had not been subject to rigourous long term studies in Bipolar Disorder.Case presentation:We report the case of a 75 year old woman who presented with treatment refractory bipolar depression. Because of insufficient response to previous mood stabilizer treatment and refractory depressive symptoms, bupropion was added to venlafaxine and lamotrigine. From there onwards, the patient improved continuously without experiencing deterioration of depression or a switch into hypomania. Our patient being on antidepressants for allmost four years experienced an obvious benefit from longterm antidepressant administration.Conclusion:Noradrenergic/dopaminergic mechanisms of action may play a more prominent role in bipolar depression, and may still be underused as a therapeutic strategy in the acute phase as well as in long-term maintenance in at least a subgroup of bipolar patients. There is still a lack of evidence from RCTs, but this case report further supports antidepressant long-term continuation and the usefulness of a noradrenergic/dopaminergic antidepressant in the acute and maintenance treatment of bipolar disorder.

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Evidence-based maintenance treatment of bipolar disorder

10.1093/med/9780198748625.003.0008 ◽

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.

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Late-Life Depression and Bipolar Disorder: Factors Affecting Long-Term Prognosis and Maintenance Treatment Outcomes

Mood Disorders in Later Life - Medical Psychiatry ◽

10.3109/9781420053302.019 ◽

2008 ◽

pp. 347-362

Author(s):

Julie A Kmiec ◽

Ariel Gildengers ◽

Robert C Young ◽

Charles F Reynolds

Keyword(s):

Bipolar Disorder ◽

Treatment Outcomes ◽

Maintenance Treatment ◽

Late Life ◽

Late Life Depression ◽

Factors Affecting ◽

Long Term Prognosis

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Maintenance Pharmacological Treatment of Juvenile Bipolar Disorder: Review and Meta-Analyses

The International Journal of Neuropsychopharmacology ◽

10.1093/ijnp/pyz034 ◽

2019 ◽

Vol 22 (8) ◽

pp. 531-540 ◽

Cited By ~ 1

Author(s):

Caitlin S Yee ◽

Emily R Hawken ◽

Ross J Baldessarini ◽

Gustavo H Vázquez

Keyword(s):

Bipolar Disorder ◽

Clinical Response ◽

Maintenance Treatment ◽

Controlled Trial ◽

Gastrointestinal Symptoms ◽

Term Treatment ◽

Placebo Control ◽

Pharmacological Treatments ◽

Long Term Treatment

Abstract Background Guidelines for maintenance treatment of juvenile bipolar disorder rely heavily on evidence from adult studies and relatively brief trials in juveniles, leaving uncertainties about optimal long-term treatment. We aimed to systematically review long-term treatment trials for juvenile bipolar disorder. Methods We analyzed data recovered by a systematic literature search using the PRISMA guidelines statement, through 2018, for peer-reviewed reports on pharmacological treatments for juvenile bipolar disorder lasting ≥24 weeks. Results Of 13 reports with 16 trials of 9 treatments (18.8% were randomized and controlled), with 1773 subjects (94.4% BD-I; ages 6.9–15.1 years), lasting 11.7 (6–22) months. Pooled clinical response rates were 66.8% (CI: 64.4–69.1) with drugs vs 60.6% (53.0–66.7) in 3 placebo-control arms. Random-effects meta-analysis of 4 controlled trials yielded pooled odds ratio (OR) = 2.88 ([0.87–9.60], P = .08) for clinical response, and OR = 7.14 ([1.12–45.6], P = .04) for nonrecurrence. Apparent efficacy ranked: combined agents >anticonvulsants ≥lithium ≥antipsychotics. Factors favoring response ranked: more attention deficit/hyperactivity disorder, polytherapy, randomized controlled trial design, nonrecurrence vs response. Adverse events (incidence, 5.50%–28.5%) notably included cognitive dulling, weight-gain, and gastrointestinal symptoms; early dropout rates averaged 49.8%. Conclusions Pharmacological treatments, including anticonvulsants, lithium, and second-generation antipsychotics, may reduce long-term morbidity in juvenile bipolar disorder. However, study number, quality, and effect magnitude were limited, leaving the status of scientific support for maintenance treatment for juvenile bipolar disorder inconclusive.

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SS06-01 - Are we getting the most out of combination therapy in the short-term and long-term treatment of mania?

European Psychiatry ◽

10.1016/s0924-9338(11)73884-6 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 2181-2181

Author(s):

S. Kasper ◽

E. Vieta ◽

F. Bellivier ◽

M. Frye

Keyword(s):

Bipolar Disorder ◽

Combination Therapy ◽

Maintenance Treatment ◽

Treatment Guidelines ◽

Single Agent ◽

First Line ◽

Short Term ◽

Long Term Treatment ◽

Study Designs

The extensive research into the treatment of bipolar disorder over the last 20 years means that we, as clinicians, have never been in a better position to treat patients with bipolar disorder. Yet despite the availability of modern, evidence-based treatment guidelines, bipolar disorder remains an everyday treatment challenge. Newly diagnosed patients requiring treatment for the first time are not always adequately controlled with single-agent therapy and, similarly, combination therapy is also frequently necessary as maintenance treatment. But with this recognition comes the new challenge of identifying when monotherapy is not enough, which agents to combine, when and for how long? How do we know?Joined by an internationally respected faculty, Professor Siegfried Kasper chairs a discussion to help answer some of the key questions facing clinicians today:What response can be anticipated from recommended first-line monotherapies for acute mania?How do we know whether the response we observe when we prescribe a first-line treatment in a manic patient is adequate?To what extent can a partial non-response to monotherapy be improved by the addition of a second agent?What's the benefit of maintaining combination treatment once patients are stable and how long should I continue?Does adding an antipsychotic to a mood stabiliser increase the risk of adverse events, in the short term or in the long term?Drawing on latest guideline recommendations, recent clinical research, case studies and their extensive clinical experience, the panel will debate these interesting questions and shed light on how we can optimize both acute and maintenance treatment in this patient group.Although the design of maintenance studies in bipolar disorder has significantly evolved in recent years, individual study designs continue to differ in important ways, with important implications. What may appear to be small differences between study designs, such as the type of most recent episode experienced by the patients or the stabilisation criteria used in the trial, can have big implications for study outcome. It is thus becoming increasingly important to be able to evaluate the results of trials within the context of the design and determine what they mean for treatment practice. Our panel will therefore also discuss the extent to which the design of bipolar maintenance studies can influence the results achieved and share their views on what this means for treatment now, and in the future.Are we, and more importantly our patients, getting the most out of combination therapy for bipolar mania? Come and debate the issues with the panel, share your views and see what can be achieved.

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