Stabilization Beyond Mood: Stabilizing Patients With Bipolar Disorder in the Various Phases of Life

Alessio Simonetti; Alexia E Koukopoulos; Georgios D Kotzalidis; Delfina Janiri; Lavinia De Chiara; Luigi Janiri; Gabriele Sani

doi:10.3389/fpsyt.2020.00247

Stabilization Beyond Mood: Stabilizing Patients With Bipolar Disorder in the Various Phases of Life

Front Psychiatry. 2020 Apr 27:11:247. doi: 10.3389/fpsyt.2020.00247. eCollection 2020.

Authors

Alessio Simonetti^{1

2

3}, Alexia E Koukopoulos^{3

4}, Georgios D Kotzalidis^{3

5}, Delfina Janiri^{2

3}, Lavinia De Chiara^{3

5}, Luigi Janiri^{6

7}, Gabriele Sani^{6

7}

Affiliations

¹ Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.
² Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
³ Centro Lucio Bini, Rome, Italy.
⁴ Azienda Ospedaliera Universitaria Policlinico Umberto I, Sapienza School of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy.
⁵ NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy.
⁶ Institute of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy.
⁷ Department of Psychiatry, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy.

Abstract

Background: There are different ways to define stabilization and currently, the main standpoint regards it as no-depression/no-mania. Furthermore, each person is physiologically different from childhood to adulthood, and in old age, thus the meaning of stabilization should take into account both growth and maturity. We aimed to review systematically studies focusing on mood stabilization in all phases of bipolar disorder (BD) and across all life phases, including pregnancy and the perinatal period, which is still a different phase in women's life cycles.

Methods: We carried out a PubMed search focusing on studies of bipolar disorder treated with drugs and aimed at stabilization with the following search strategy stabiliz*[ti] OR stabilis*[ti] OR stable[ti] OR stability[ti]) AND mood[ti] AND bipolar. In conducting our review, we followed the PRISMA statement. Agreement on inclusion was reached by consensus of all authors through a Delphi rounds procedure.

Results: The above search strategy produced 509 records on January 25, 2020. Of them, 58 fitted our inclusion criteria and were discussed. The eligible studies spanned from September 1983 to July 6, 2019.

Conclusions: No clear-cut indications could be drawn due to a number of limitations involving sample inconsistency and different methods of assessing mood stabilization. The evidence collected so far does not allow recommended treatments for Adolescents, pregnant or perinatal women, and aged patients. However, adults, not within these groups, better focused upon. For their manic/mixed phases, second generation antipsychotic drugs may be useful in the short-to-medium run, alone or combined with mood stabilizers (MSs). However, MSs, and especially lithium, continue to be pivotal in chronic treatment. Bipolar depression should rely on MSs, but an antidepressant may be added on and can prove to be helpful. However, there are concerns with the tendency of antidepressants to induce the opposite polarity or mood instability, rendering the need for concurrent MS prescription mandatory.

Keywords: antidepressant drugs; antipsychotic drugs; lithium; mood; mood stabilizers; stabilization.

Publication types

Systematic Review