Bipolar disorder: an update

Postgrad Med. 2010 Jul;122(4):24-31. doi: 10.3810/pgm.2010.07.2172.

Abstract

There has been a recent increase in the number of clinical trials and treatment options for bipolar disorder. This research has resulted in new treatment options. Most second-generation antipsychotics have demonstrated efficacy in the treatment of mania, both in monotherapy and as adjuncts to mood stabilizers. For bipolar depression, nearly all randomized, placebo-controlled studies have demonstrated that antidepressants do not provide any additional benefit to ongoing mood stabilizers. Additionally, antidepressants carry a risk of destabilization of bipolar disorder with an increase in mania, cycling, and chronic irritable dysphoria. Newer non-antidepressant treatments for depression include quetiapine, lamotrigine, modafinil, and pramipexole. These agents are effective for acute treatment and appear to be effective in maintenance. The least-studied phase of bipolar disorder is the maintenance phase. The use of multiple agents appears to be superior to monotherapy in relapse prevention. Despite the many advances in the pharmacotherapy of bipolar disorder, the overall prognosis of this severe illness does not appear to have changed.

Publication types

  • Review

MeSH terms

  • Anticonvulsants / adverse effects
  • Anticonvulsants / therapeutic use*
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / therapeutic use*
  • Antipsychotic Agents / adverse effects
  • Antipsychotic Agents / therapeutic use*
  • Benzhydryl Compounds / adverse effects
  • Benzhydryl Compounds / therapeutic use*
  • Benzothiazoles / adverse effects
  • Benzothiazoles / therapeutic use*
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / drug therapy*
  • Diagnosis, Differential
  • Dibenzothiazepines / adverse effects
  • Dibenzothiazepines / therapeutic use*
  • Dopamine Agonists / adverse effects
  • Dopamine Agonists / therapeutic use*
  • Humans
  • Lamotrigine
  • Modafinil
  • Pramipexole
  • Prognosis
  • Psychotherapy
  • Quetiapine Fumarate
  • Randomized Controlled Trials as Topic
  • Triazines / adverse effects
  • Triazines / therapeutic use*

Substances

  • Anticonvulsants
  • Antidepressive Agents
  • Antipsychotic Agents
  • Benzhydryl Compounds
  • Benzothiazoles
  • Dibenzothiazepines
  • Dopamine Agonists
  • Triazines
  • Quetiapine Fumarate
  • Pramipexole
  • Modafinil
  • Lamotrigine