The treatment of mixed states and the risk of switching to depression.
There are few controlled studies evaluating the treatment of bipolar mixed states. Evidence suggests that mixed states may be more responsive to some anticonvulsants than to lithium. Olanzapine alone or in combination with divalproate or lithium has been adequately evaluated in randomized clinical trials involving mixed-state patients, whereas risperidone and quetiapine have not. There is also some evidence demonstrating the efficacy of ziprasidone and aripiprazole. The risk of switching to depression is high in mixed states. Conventional antipsychotics, such as haloperidol, may be less efficacious at protecting against a switch to depression than atypical antipsychotics, divalproate or lithium. When choosing drugs for the treatment of mania, and especially for the treatment of mixed states, their efficacy against manic and depressive symptoms, and their safety in terms of the risk of switching to depression should be taken into account.
Vieta
Eduard
E
Department of Psychiatry, Hospital Clinic, IDIBAPS, Clinical Institute of Neuroscience, University of Barcelona, Villarroel 170/Rossello 140, 8036 Barcelona, Spain. evieta@clinic.ub.es
D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy*; D003987:Dibenzothiazepines / Q000627:therapeutic use; D004565:Electroconvulsive Therapy / Q000379:methods; D006220:Haloperidol / Q000627:therapeutic use; D006266:Health Education; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D000077152:Olanzapine; D010879:Piperazines / Q000627:therapeutic use; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use
D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010879:Piperazines; D015363:Quinolones; D013844:Thiazoles; D001569:Benzodiazepines; D016651:Lithium Carbonate; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D000068180:Aripiprazole; D006220:Haloperidol; D000077152:Olanzapine