Rethinking the treatment paradigm for bipolar depression: the importance of long-term management.
The need for long-term management of bipolar disorder is evident. Bipolar patients spend more time depressed than manic; however, few agents used for maintenance therapy of bipolar disorder have demonstrated good efficacy in delaying relapse into depression. This article provides a comprehensive review of open-label and randomized, controlled studies examining prophylactic efficacy in bipolar disorder, especially bipolar depression. Lithium, considered the gold standard for bipolar disorder maintenance therapy may be more effective in delaying manic relapse than in delaying depressive relapse. Evidence for the efficacy of divalproex and carbamazepine in delaying depressive relapse is yet to be fully elucidated. Lamotrigine has demonstrated efficacy in delaying time to depressive relapse. Unpublished studies show olanzapine's efficacy in preventing manic recurrence, while its efficacy in preventing depressive recurrence is yet to be proven. As patients with bipolar disorder are prone to experiencing depressive episodes, more attention needs to be focused on preventing depressive relapse. To date, three agents--lithium, lamotrigine, and olanzapine--have been shown to have prophylactic benefits in treating this highly recurrent disorder.
Baldassano
Claudia F
CF
Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. cfb@mail.med.upenn.edu
Ballas
Christos A
CA
O'Reardon
John P
JP
D000588:Amines / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D002220:Carbamazepine / Q000627:therapeutic use; D002908:Chronic Disease; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D000077213:Lamotrigine; D016651:Lithium Carbonate / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013995:Time; D000077236:Topiramate; D014227:Triazines / Q000627:therapeutic use; D014635:Valproic Acid / Q000627:therapeutic use; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D003509:Cyclohexanecarboxylic Acids; D014227:Triazines; D000077236:Topiramate; D016651:Lithium Carbonate; D005632:Fructose; D002220:Carbamazepine; D005680:gamma-Aminobutyric Acid; D014635:Valproic Acid; D000077206:Gabapentin; D000077213:Lamotrigine