title: Monotherapy versus combined treatment with second-generation antipsychotics in bipolar disorder.
abstract: The American Psychiatric Association guidelines for treating bipolar disorder recommend combination therapies to treat patients experiencing severe acute manic or mixed episodes and breakthrough manic or mixed episodes during maintenance therapy. Combination therapies approved by the U.S. Food and Drug Administration for the treatment of acute manic states include the use of second-generation antipsychotics, such as olanzapine, risperidone, quetiapine, and aripiprazole in combination with lithium or divalproex; for the treatment of acute bipolar depression, the olanzapine plus fluoxetine combination; and for maintenance treatment, quetiapine combined with lithium or valproate. When combining medications for the management of patients with bipolar disorders, physicians face a potentially complex treatment strategy. Available agents have different mechanisms of action, routes of metabolism and excretion, therapeutic effects, and side effects. Combining treatments can be advantageous owing to therapeutic synergy; however, the liability is an increased possibility of adverse effects. The decision to use a combination therapy should be made on the basis of the efficacy, tolerability, and safety of each medication and their specific combination for individual patients.
authors.affiliation: Department of Psychiatry and Behavior Sciences and Bipolar Disorders Clinic, Stanford University School of Medicine, 401 Quarry Rd., Rm 2124, Stanford, CA 94305-5723, USA. tketter@stanford.edu
authors.forename: Terence A
authors.initials: TA
authors.lastname: Ketter
mesh_terms: D000208:Acute Disease; D000339:Affect / Q000187:drug effects; D000927:Anticonvulsants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D018692:Antimanic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D002220:Carbamazepine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D004311:Double-Blind Method; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005473:Fluoxetine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014481:United States; D014486:United States Food and Drug Administration; D014635:Valproic Acid / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D005473:Fluoxetine; D016651:Lithium Carbonate; D002220:Carbamazepine; D014635:Valproic Acid