Bipolar disorder

Bipolar disorder requires treatment of depressive and manic or hypomanic episodes together with long-term treatment to prevent future episodes, both syndromal and sub-syndromal. In recent years the importance of long-term treatment (that is, maintenance treatment) has been emphasised by several guidelines. The need for maintenance treatment is supported by the desire to prevent the costs of future episodes, that is, the intangible suffering to patients and their families and the economic burden of direct and indirect costs. In addition maintenance treatment may reduce long-term impairment associated with the bipolar disorder. There is evidence that functional impairment in patients who have recovered from acute episodes and are asymptomatic is related to the number of previous depressive episodes. The tendency for episodes to become more frequent with time also supports the rationale for maintenance treatment.

In the last decade, evidence from RCTs has accumulated regarding the effectiveness of several ‘new’ agents in the treatment of bipolar disorder. These include valproate (in various forms), lamotrigine and various atypical antipsychotics. The active control arms in several such studies have provided further evidence for the efficacy of ‘older’ treatments, in particular haloperidol (a conventional antipsychotic) in the treatment of mania and lithium in the prophylaxis of mania.

 

  • Bipolar disorder
  • Cyclothymic Disorder
  • Brain Structure and Functioning
  • Genetics
  • Family History

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