S-09-01

E. Vieta. University of Barcelona Hospital Clinic, Barcelona, Spain

Objective: To address the issues related to the gap between efficacy and efectiveness in the treatment of bipolar disorder.

Methods: A systematic review of the literature, including all relevant contrlled and naturalistic trials, was conducted.

Results: The management of bipolar disorder has traditionally focused upon the treatment of acute mania and although this is a fundamental aspect of patients' care, other aspects of mood stabilisation, e.g. treatment of depression, have been overshadowed. Most of the problems come when decisions are based only on the potential efficacy of treatments, rather than effectiveness. Efficacy responds to the question: Does a treatment work under ideal conditions?, whereas effectiveness responds to the question: Does a treatment work under the conditions of routine care? The answer to the second question should be more relevant to clinicians. Indeed, the mood-stabilising agent lithium, introduced in 1949 as a treatment for mania is the mainstay of long-term treatment of bipolar disorder and is in widespread clinical use. However, lithium has a slow onset of action and is not very well tolerated, so despite its efficacy, effectiveness is quite low. Of those patients with bipolar disorder who receive treatment, noncompliance with medication is a significant problem. When associated with lithium treatment in particular, noncompliance increases the risk of relapse. The need for well-tolerated agents with efficacy in depression as well as mania, has led researchers to evaluate the potential of a variety of anticonvulsants, antidepressants and antipsychotics as primary or adjunctive, which have proved to be efficacious and generally safer than the older drugs. However, research in this area has basically been conducted for registration purposes, and little is known about the true effectiveness of novel treatments in clinical practice.

Conclusion: There is a gap between research and clinical practice. Large, unbiased open randomised and observational studies are urgently needed to learn more about the true effectiveness of novel treatments for bipolar disorder.

S-09-02

H. Grunze. LMU Psychiatry, Munich, Germany

S-09-03

R. Bottlender. Psychiatrische Klinik der Ludw, Miinchen, Germany