Is treatment for bipolar disorder more effective earlier in illness course? A comprehensive literature review.
BACKGROUND
We aimed to investigate a key element of the early intervention approach whether treatment at an earlier stage of bipolar disorder is more effective than later in its course.


METHODS
A comprehensive literature review using Medline, Embase, Psychinfo, PsycArticle, and Web of Science, as data sources, with a subsequent narrative synthesis. Study quality was assessed using the Cochrane risk of bias method.


RESULTS
Our search strategy yielded eight primary papers and two meta-analyses (of psychological therapies and Olanzapine) in total representing 8942 patients. Five studies focused on comparisons between first and multiple episodes, and the others on fewer vs more episode categories. There was a consistent finding, suggesting treatment in earlier illness stage resulted in better outcomes in terms of response, relapse rate, time to recurrence, symptomatic recovery, remission, psychosocial functioning, and employment. This effect was found for pharmacological (Lithium, Olanzapine, Divalproex) and psychological treatments.


CONCLUSIONS
There was high risk of selection, performance, and attrition bias in most studies. First admission or presentation is unlikely to equate to first episode, because of the duration of untreated illness. Some patients having experienced multiple episodes could be "treatment resistant". Study heterogeneity precluded meta-analysis.


CONCLUSIONS
Psychological and pharmacological treatments in the early stages of illness are more effective than in the later stages of bipolar disorder across multiple domains. There is a first episode and the early phase effect. Consistent with the staging model of illness, findings provide evidence for the clinical utility of an early intervention approach in bipolar disorder to improve patient outcomes.
Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
Katie
K
Joyce
Unit of Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.|North Warwickshire Early Intervention in Psychosis Service, Coventry and Warwickshire NHS Partnership Trust, Coventry, UK.
Andrew
A
Thompson
Unit of Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. s.marwaha@warwick.ac.uk.|Affective Disorders Service (IPU 3-8), Caludon Centre, Coventry, UK. s.marwaha@warwick.ac.uk.
Steven
http://orcid.org/0000-0002-0303-9942
S
Marwaha
Bipolar disorder; Early intervention; Effectiveness; First episode; Multiple episodes; Treatment