Comorbidity in bipolar disorder: a framework for rational treatment selection.
Bipolar disorders are heterogeneous disorders often requiring multimodality treatment. The expanding pharmacopeia for bipolar disorders invites the need for a treatment framework that both recognizes and anticipates the multidimensionality and comorbidity of the illness. No available neurotherapeutic agent is singularly efficacious for the complete mélange of bipolar symptomatology. An apparent paradox has emerged in the management of bipolar disorder; whilst results from rigorous controlled monotherapy trials suggest that a disparate assortment of neurotherapeutic agents are efficacious in distinct phases of bipolar disorder, the majority of tertiary-treated bipolar patients receive polypharmacotherapeutic regimens. The evidentiary base for polypharmacotherapy is sparse and has recently become an area of active research focus. In the interim, clinicians are encouraged to invoke an organizational schema for the treatment of bipolar disorder that considers the spectrum of effectiveness of putative and established mood stabilizers. This schema should be further informed by the treatment data for comorbid and accessory conditions. The authors propose a schema to provide the impetus for further work in the area.
McIntyre
Roger S
RS
Mood Disorder Psychopharmacology Unit, University of Toronto, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S9, Canada. rmcintyr@uhnres.utoronto.ca
Konarski
Jakub Z
JZ
Yatham
Lakshmi N
LN
D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000628:therapy*; D002986:Clinical Trials as Topic; D015897:Comorbidity; D004565:Electroconvulsive Therapy / Q000379:methods; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D018579:Patient Selection; D011569:Psychiatric Status Rating Scales; D019966:Substance-Related Disorders / Q000453:epidemiology*; D016896:Treatment Outcome
D018692:Antimanic Agents