title: Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry.
abstract: The current statement is a systematic review of the available data concerning the efficacy of medication treatment of bipolar disorder (BP). A systematic MEDLINE search was made concerning the treatment of BP (RCTs) with the names of treatment options as keywords. The search was updated on 10 March 2012. The literature suggests that lithium, first and second generation antipsychotics and valproate and carbamazepine are efficacious in the treatment of acute mania. Quetiapine and the olanzapine-fluoxetine combination are also efficacious for treating bipolar depression. Antidepressants should only be used in combination with an antimanic agent, because they can induce switching to mania/hypomania/mixed states/rapid cycling when utilized as monotherapy. Lithium, olanzapine, quetiapine and aripiprazole are efficacious during the maintenance phase. Lamotrigine is efficacious in the prevention of depression, and it remains to be clarified whether it is also efficacious for mania. There is some evidence on the efficacy of psychosocial interventions as an adjunctive treatment to medication. Electroconvulsive therapy is an option for refractory patients. In acute manic patients who are partial responders to lithium/valproate/carbamazepine, adding an antipsychotic is a reasonable choice. The combination with best data in acute bipolar depression is lithium plus lamotrigine. Patients stabilized on combination treatment might do worse if shifted to monotherapy during maintenance, and patients could benefit with add-on treatment with olanzapine, valproate, an antidepressant, or lamotrigine, depending on the index acute phase. A variety of treatment options for BP are available today, but still unmet needs are huge. Combination therapy may improve the treatment outcome but it also carries more side-effect burden. Further research is necessary as well as the development of better guidelines and algorithms for the step-by-step rational treatment.
authors.affiliation: 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, 6 Odysseos str./1st Parodos Ampelonon str., Pylaia, Thessaloniki, Greece. kfount@med.auth.gr
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Fountoulakis
authors.forename: Siegfried
authors.initials: S
authors.lastname: Kasper
authors.forename: Ole
authors.initials: O
authors.lastname: Andreassen
authors.forename: Pierre
authors.initials: P
authors.lastname: Blier
authors.forename: Ahmed
authors.initials: A
authors.lastname: Okasha
authors.forename: Emanuel
authors.initials: E
authors.lastname: Severus
authors.forename: Marcio
authors.initials: M
authors.lastname: Versiani
authors.forename: Rajiv
authors.initials: R
authors.lastname: Tandon
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Möller
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
mesh_terms: D000208:Acute Disease; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000145:classification / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000145:classification / Q000627:therapeutic use*; D001521:Behavior Therapy; D001714:Bipolar Disorder / Q000188:drug therapy*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy; D006801:Humans; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents