Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-18T18:42:00.034Z Has data issue: false hasContentIssue false
  • English
  • Français

Rethinking the Treatment Paradigm for Bipolar Depression: The Importance of Long-Term Management

Published online by Cambridge University Press:  07 November 2014

Claudia F. Baldassano ,
Christos A. Ballas  and
John P. O'Reardon
Get access Rights & Permissions [Opens in a new window]

Abstract:

The need for long-term management of bipolar disorder is evident. Bipolar patients spend more time depressed than manic; however, few agents used for maintenance therapy of bipolar disorder have demonstrated good efficacy in delaying relapse into depression. This article provides a comprehensive review of open-label and randomized, controlled studies examining prophylactic efficacy in bipolar disorder, especially bipolar depression. Lithium, considered the gold standard for bipolar disorder maintenance therapy may be more effective in delaying manic relapse than in delaying depressive relapse. Evidence for the efficacy of divalproex and carbamazepine in delaying depressive relapse is yet to be fully elucidated. Lamotrigine has demonstrated efficacy in delaying time to depressive relapse. Unpublished studies show ohnzapine's efficacy in preventing manic recurrence, while its efficacy in preventing depressive recunence is yet to be proven. As patients with bipohr disorder are prone to experiencing depressive episodes, more attention needs to be focused on preventing depressive relapse. To date, three agents—lithium, lamotrigine, and olanzapine—have been shown to have prophylactic benefits in treating this highly recunent disorder.

Type
Academic Supplement
Information
CNS Spectrums , Volume 9 , Issue S9 , September 2004 , pp. 11 - 18
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Goodwin, GM. Prophylaxis of bipolar disorder: how and who should we treat in the long term? Eur Neuropsychopharmacol. 1999;9(Suppl 4):S125–S129.CrossRefGoogle ScholarPubMed
2.Suppes, T, Dennehy, EB, Gibbons, EW. The longitudinal course of bipolar disorder. J Clin Psychiatry. 2000;61(Suppl 9):23–30.Google ScholarPubMed
3.Griswold, KS, Pessar, LE. Management of bipolar disorder. Am Fam Physician. 2000;62(6):1343–1348.Google ScholarPubMed
4.Botts, SR, Raskind, J. Gabapentin and lamotrigine in bipolar disorder. Am J Health Syst Pharm. 1999;56(19):1939–1944.CrossRefGoogle ScholarPubMed
5.Akiskal, HS, Bourgeois, ML, Angst, J et al. , Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord. 2000;59(Suppl 1):S5–S30.CrossRefGoogle ScholarPubMed
6.Bowden, CL, Lecrubier, Y, Bauer, M et al. , Maintenance therapies for classic and other forms of bipolar disorder. J Affect Disord. 2000;59(Suppl 1):S7–S30.CrossRefGoogle ScholarPubMed
7.Ananth, J, Wohl, M, Ranganath, V et al. , Rapid cycling patients: conceptual and ettological factors. Neuropsychobiology. 1993;27(4):193–198.CrossRefGoogle ScholarPubMed
8.Woods, SW. The economic burden of bipolar disease. J Clin Psychiatry. 2000;61(Suppl 13):38–41.Google ScholarPubMed
9.Jamison, KR. Suicide and bipolar disorder. J Clin Psychiatry. 2000;61(Suppl 9):S47–S51.Google ScholarPubMed
10.Simpson, SG, Jamison, KR. The risk of suicide in patients with bipolar disorders. J Clin Psychiatry. 1999;60(Suppl 2):S53–S56.Google ScholarPubMed
11.Mendlewicz, J, Soucry, D, Rivelli, SK. Short-term and long-term treatment for bipolar patients: beyond the guidelines. J Affect Disord. 1999;55(1):79–85.CrossRefGoogle ScholarPubMed
12.Post, RM, Leverich, GS, Altshuler, LL et al. , An overview of recent findings of the Stanley Foundation Bipolar Network (Part I). Bipolar Disord. 2003;5(5):310–319.CrossRefGoogle ScholarPubMed
13.Judd, LL, Schettler, PJ, Akiskal, HS et al. , Long-term symptomatic status of bipolar Ivs. bipolar II disorders. Int J Neuropsychopharmacol. 2003;6(2):127–137.CrossRefGoogle Scholar
14.Hilty, DM, Brady, KT, Hales, RE. A review of bipolar disorder among adults. Pschiatr Serv. 1999;50(2):201–213.CrossRefGoogle ScholarPubMed
15.Sachs, GS, Thase, ME. Bipolar disorder therapeutics: maintenance treatment. Biol Pschiatry. 2000:48(6):573–531.CrossRefGoogle ScholarPubMed
16.Sachs, GS, Printz, DJ, Kahn, DA et al. , The expert consensus guidelines series: medication treatment of bipolar disorder 2000. Postgrad Med. 2000;Spccial Issue:1–104.Google ScholarPubMed
17.Boastrup, PC, Poulscn, JC, Schou, M et al. , Prophylactic lithium: double blind discontinuation in manic-depressive and recurrent-depressive disorders. Lancet. 1970;2(7668):326–330.CrossRefGoogle Scholar
18.Prien, RF, Caffey, EM Jr, Klett, CJ. Prophylactic efficacy of lithium carbonate in manic-depressive illness. Report of the Veterans Administration and National Institute of Mental Health collaborative study group. Arch Gen Psychiatry. 1973;28(3):337–341.CrossRefGoogle ScholarPubMed
19.Davis, JM, Janicak, PG, Hogan, DM. Mood stabilizers in the prevention of recurrent affective disorders: a meta-analysis. Acta Psychiatr Scand. 1999;100(6):406–417.CrossRefGoogle ScholarPubMed
20.Baldessarini, RJ, Tondo, L. Does lithium treatment still work? Evidence of stable responses over three decades. Arch Gen Psychiatry. 2000;57(2):187–190.CrossRefGoogle ScholarPubMed
21.Rybakowski, JK, Chlopocka-Wozniak, M, Suwalska, A. The prophylactic effect of long-term lithium administration in bipolar patients entering treatment in the 1970s and 1980s. Bipolar Disord. 2000;3(2):63–67.CrossRefGoogle Scholar
22.Berghofer, A, Muller-Orlinghausen, B. Is there a loss of efficacy of lithium in patients treated for over 20 years? Neuropsychobiology. 2000;42(Suppl 1):S46–S49.CrossRefGoogle Scholar
23.Tondo, L, Boldessarini, RJ. Reduced suicide risk during lithium maintenance treatment. J Clin Psychiatry. 2000;61:(Suppl 9):S97–S104.Google ScholarPubMed
24.Dickson, WE, Kendell, RE. Does maintenance lithium therapy prevent recurrences of mania under ordinary clinical conditions? Psychol Med. 1986;16(3):521–530.CrossRefGoogle ScholarPubMed
25.Gershon, S, Soares, JC. Current therapeutic profile of lithium. Arch Gen Psychiatry. 1997;54(1):16–20.CrossRefGoogle ScholarPubMed
26.Post, RM, Ketter, TA, Pazzaglia, PJ et al. , Rational polypharmacy in the bipolar affective disorders. Epilepsy Res Suppl. 1996;11:153–180.Google ScholarPubMed
27.Baldessarini, RJ, Tondo, L, Floris, G et al. , Effects of rapid cycling on response to lithium maintenance tfearment in 360 bipolar I and II disorder patients. J Affect Disord. 2000;61(1–2):13–22.CrossRefGoogle ScholarPubMed
28.Dunner, DL, Fieve, RR. Clinical faaors in lithium carbonate prophylaxis failure. Arch Gen Psychiatry. 1974;30(2):229–233.CrossRefGoogle ScholarPubMed
29.Wehr, TA, Goodwin, FK. Rapid cycling in manic-depressives induced by tricyclic antidepressants. Arch Gen Psychiatry. 1979;36(5):555–559.CrossRefGoogle ScholarPubMed
30.Dunner, DL, Patrick, V, Fieve, RR. Rapid cyling manic depressive patients. Compr Psychiatry. 1977;18(6):561–566.CrossRefGoogle Scholar
31.Levy, JM, Remick, RA. Clinical aspects and treatment of rapid cycling mood disorders. Can J Psychiatry. 1986;31(5):436–441.CrossRefGoogle ScholarPubMed
32.Okuma, T. Effects of carbomazepine and lithium on affective disorders. Neuropsychobiology. 1993;27(3):138–145.CrossRefGoogle Scholar
33.Kulhara, P, Basu, D, Mattoo, SK et al. , Lithium prophylaxis of recurrent bipolar affective disorder long-term outcome and its psychosocial correlates. J Affect Disord. 1999;54(1–2):87–96.CrossRefGoogle ScholarPubMed
34.Maj, M, Pirozi, R, Magliano, L et al. , Long-term outcome of lithium prophylaxis in bipolar disorder a 5-year prospective study of 402 patients at a lithium clinic. Am J Psychiatry. 1998;155(1):30–35.CrossRefGoogle Scholar
35.Vojta, C, Kinosian, B, Glick, H et al. , Self-reported quality of life across mood states in bipolar disorder. Compr Psychiatry. 2001;42(3):190–195.CrossRefGoogle ScholarPubMed
36.Thase, ME, Sachs, GS. Bipolar depression: pharmacotherapy and related therapeutic strategies. Biol Psychiatry. 2000;48(6):558–572.CrossRefGoogle ScholarPubMed
37.American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (Revision). Am J Psychiatry. 2002;159(4 Suppl):S1–S50.Google Scholar
38.Nemeroff, CB, Evans, DL, Gyulai, L et al. , Double-blind, placebo-controlled comparison of imipramine and paroxetine in the treatment of bipolar depression. Am J Psychiatry. 2001;158(6):906–912.CrossRefGoogle ScholarPubMed
39.Manning, JS, Connor, PD, Sahai, A. The bipolar spectrum: a review of current concepts and implications for the management of depression in primary care. Arch Fam Med. 1998;7(1):63–71.CrossRefGoogle ScholarPubMed
40.Calabrese, JR, Rapport, DJ, Shelton, MD et al. , Clinical studies on the use of lamotrigine in bipolar disorder. Neuropsychobiology. 1998;38(3):185–191.CrossRefGoogle ScholarPubMed
41.Altshuler, L, Kirinkos, L, Calcagno, J et al. , The impact of antidepressant discontinuation versus antidepressant continuation on 1-year risk for relapse of bipolar depression: a retrospective chart review. J Clin Psychiatry. 2001;62(8):612–616.CrossRefGoogle ScholarPubMed
42.Altshuler, LL, Post, RM, Leverich, GS et al. , Antidepressant-induced mania and cycle acceleration: A controversy revisited. Am J Psychiatry. 1995;152(8):1130–1138.Google ScholarPubMed
43.Kilzieh, N, Akiskal, HS. Rapid-cycling bipolar disorder. An overview of research and clinical experience. Psychiatr Clin North Am. 1999;22(3):585–607.CrossRefGoogle ScholarPubMed
44.Wehr, TA, Goodwin, FK. Do antidepressants cause mania? Psychopharmacol Bull. 1937;23(1):61–65.Google Scholar
45.Altshuler, LL, Post, RM, Leverich, GS et al. , Antidepressant-induccd mania and cyle acceleration: A controversy revisited. Am J Psychiatry. 1995;152(8):1130–1138.Google Scholar
46.Ghaemi, SN, Boiman, EE, Goodwin, FK. Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study. J Clin Psychiatry. 2000;61(10):804–808.CrossRefGoogle ScholarPubMed
47.Gelenberg, AJ, Kane, JM, Keller, MB et al. , Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorder. N Engl J Med. 1989;321(22):1489–1493.CrossRefGoogle ScholarPubMed
48.Veronese, L, Chen, C, Peck, R. Lamotrigine does not cause clinically relvent changes in the pharmacokinetics of lithium. Eur Psychopharmacol. 1998:8(Suppl 2):S194–S195.Google Scholar
49.Greil, W, Kleindienst, N. The comparative prophylactic efficacy of lithium and carbamacepine in patients with bipolar I disorder. Int Clin Psychopharmacol. 1999;14(5):277–281.CrossRefGoogle Scholar
50.Greil, W, Kleindienst, N, Erazo, N et al. , Differential response to lithium and carbamazepine in the prophylaxis of bipolar disorder. J Clin Psychopharmacol. 1998;18(6):455–460.CrossRefGoogle ScholarPubMed
51.Kleindienst, N, Greil, W. Differential efficacy of lithium and carbomazepine in the prophylaxis of bipolar disorder results of the MAP study. Neuropsychobiology. 2000;42(Suppl 1):S2–S10.CrossRefGoogle Scholar
52.Greil, W, Ludwig-Mayerhofer, W, Erazo, N et al. , Lithium versus carbomazepine in the maintenance treatment of bipolar disorders-a randomised study. J Affect Disord. 1997;43(2):151–161.CrossRefGoogle Scholar
53.Calabrese, JR, Delucchi, GA. Spectrum of efficacy of valproate in 55 patients with rapid-cycling bipolar disorder. Am J Psychiatry. 1990;147(4):431–434.Google ScholarPubMed
54.Bowden, CL, Calabrese, JR, McElroy, SL et al. , A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintenance Study Group. Arch Gen Psychiatry. 2000;57(5):481–489.CrossRefGoogle ScholarPubMed
55.Baldessarini, RJ, Tohen, M, Tondo, L. Maintenance treatment in bipolar disorder. Arch Gen Psychiatry. 2000;57(5):490–492.CrossRefGoogle ScholarPubMed
56.Bowden, CL, Calabrese, JR, Sachs, G et al. , A pbcebo-controllcd 18-month trial of Lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry. 2003;60(4):392–400.CrossRefGoogle ScholarPubMed
57.Calabrese, JR, Bowden, CL, Sachs, G et al. , A placebo controlled 18 month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. J Clin Psychiatry. 2003;64(9):1013–1024.CrossRefGoogle ScholarPubMed
58.Bowden, CL, Ghaemi, SN, Gyulai, L et al. , Lamotrigine delays mood episodes in recently depressed bipolar I patients (605 data). Presented at 155th Annual Meeting of the American Psychiatric Association; May 2002; Philadelphia, PA.CrossRefGoogle Scholar
59.Calabrese, JR, Suppes, T, Bowden, CL et al. , A double-blind, placebo-controlled, prophylaxis study of lamotrigine in rapid-cycling bipolar disorder. Lamictal 614 Study Group. J Clin Psychiatry. 2000:61(11):841–850.CrossRefGoogle ScholarPubMed
60.Calabrese, JR, Sullivan, JR, Bowden, CL et al. , Rash in multicenter trials of lamotrigine in mood disorders: clinical relevance and management. J Clin Psychiatry. 2002;63(11):1012–1019.CrossRefGoogle ScholarPubMed
61.Tohen, M, Sanger, TM, McElroy, SL et al. , Olanzapine versus placebo in the treatment of acute mania. Olanzapine HGEH Study Group. Am J Psychiatry. 1999;156(5):702–709.CrossRefGoogle ScholarPubMed
62.Tohen, M, Jacobs, TG, Grundy, SL et al. , Efficacy of olanzapine in acute bipolar mania: a double-blind, placebo- controlled study. The Olanzapine HGGW Study Group. Arch Gen Psychiatry. 2000;7(9):841–849.CrossRefGoogle Scholar
63.Tohen, MF, Bowden, CL, Calabrese, JR, Sachs, GS, Jacobs, T, Baker, RW. Olanzapine versus placebo for relapse prevention in bipolar disorder. Presented at 156th Annual Meeting of American Psychiatric Association; May 17–22, 2003; San Francisco, CA.Google Scholar
64.Tohen, MF, Marneros, A, Bowden, CL et al. , Olanzapine versus lithium in relapse prevention in bipolar disorder. Presented at: 156th Annual Meeting of American Psychiatric Association; May 17–22, 2003; San Francisco, CA.Google Scholar
65.Guille, C, Sachs, GS, Ghaemi, SN. A naturalistic comparison of clozapine, risperidone, and olanzapine in the treatment of bipolar disorder. J Clin Psychiatry. 2000;61(9):638–642.CrossRefGoogle ScholarPubMed
66.Allison, DB, Mentore, JL, Heo, M et al. , Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry. 1999;156(11):1686–1696.CrossRefGoogle ScholarPubMed
67.Sanger, TM, Grundy, SL, Gibson, PJ et al. , Long-term olanzapine therapy in the treatment of bipolar I disorder an open-label continuation phase study. J Clin. Psychiatry. 2001;62(4):273–281.CrossRefGoogle ScholarPubMed
68.Koro, CE, Fedder, DO, L'Italien, GJ et al. , An assessment of the independent effects of olanzapine and risperidone exposure on the risk of hyperlipidemia in schizophrenic patients. Arch Gen Psychiatry. 2002;59(11):1021–1026.CrossRefGoogle ScholarPubMed
69.Melkersson, KI, Dahl, ML. Relationship between levels of insulin or triglycerides and serum concentrations of the atypical antipsychotics clozapine and olanzapine in patients on treatment with therapeutic doses. Psychopharmacology (Berl). 2003;170(2):157–166.CrossRefGoogle ScholarPubMed
70.Gianfrancesco, F, White, R, Wang, RH et al. , Antipsychotic-induced type 2 diabetes: evidence from a large health plan database. J Clin Psychopharmacol. 2003;23(4):328–335.CrossRefGoogle ScholarPubMed
71.Pecuch, PW, Erfurth, A. Topiramate in the treatment of acute mania. J Clin Psychopharmocol. 2001;21(2):243–244.CrossRefGoogle ScholarPubMed
72.Gordon, A, Price, LH. Mood stabilzation and weight loss with topiramate [letter]. Am J Psychiatry. 1999;156(6):968–969.CrossRefGoogle Scholar
73.Grunze, HC, Normann, C, Langosch, J et al. , Antimanic efficacy of topiramate in 11 patients in an open trial with an on-off-on design. J Clin Psychiatry. 2001;62(6):464–468.CrossRefGoogle Scholar
74.McElroy, SL, Suppes, T, Keck, PE et al. , Open-label adjunctive topiramate in the treatment of bipolar disorders. Biol Psychiatry. 2000;47(12):1025–1033.CrossRefGoogle ScholarPubMed
75.Chengappa, KN, Rathore, D, Levine, J et al. , Topiramate as add-on treatment for patients with bipolar mania. Bipolar Disord. 1999;1(1):42–53.CrossRefGoogle ScholarPubMed
76.Calabrese, JR, Keck, PE Jr., McElroy, SL et al. , A plot study of topiramate as monotherapy in the treatment of acute mania. J Clin Psychopharmacol. 2001;21(3):340–342.CrossRefGoogle Scholar
77.McElroy, SL, Keck, PE Jr.Pharmacologic agents for the treatment of acute bipolar mania. Biol Psychiatry. 2000;48(6):539–557.CrossRefGoogle ScholarPubMed
78.Ferrier, IN. Lamotrigine and gabapentin Alternative in die treatment of bipolar disorder. Neuropsychobiology. 1993;38(3):192–197.CrossRefGoogle Scholar
79.Altshuler, LL, Keck, FE Jr., McElroy, SL et al. , Gabapentin in the acute treatment of refractory bipolar disorder. Bipolar Disord. 1999;1(1):61–65.CrossRefGoogle ScholarPubMed
80.Frye, MA, Ketter, TA, Kimbrell, TA et al. , A placebo-controlled study of lamotrigine and gabapentin monotherapy in refractory mood disorders. J Clin Psychopharmacol. 2000;2(6):607–614.CrossRefGoogle Scholar
81.Pande, AC, Crockatt, JG, Janney, CA et al. , Gabapentin in bipolar disorder: a placebo-controlled trial of adjunctive therapy. Gabapentin Bipolar Disorder Study Group. Bipolar Disord. 2000;2(3 Pt 2):249–255.CrossRefGoogle ScholarPubMed
82.Teitelbaum, M. Oxcarbazepine in bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2001;40(9):993–994.CrossRefGoogle ScholarPubMed
83.Emrich, HM, Dose, M, von Zerssen, D. The use of sodium valproate, carbamazepine and oxcarbazepine in patients with affective disorders. J Affect Disord. 1985;8(3):243–250.CrossRefGoogle ScholarPubMed
84.Kukopulos, A, Reginaldi, D, Laddomada, P et al. , Course of the manic-depressive cycle and changes caused by treatment. Pharmacopsychiatr Neuropsychopharmacol. 1980;13(4):156–167.CrossRefGoogle ScholarPubMed
85.Puri, BK, Taylor, DG, Alcock, ME. Low-dose maintenance clorapine treatment in the prophylaxis of bipolar affective disorder. Br J Clin Pract. 1995;49(6):333–334.CrossRefGoogle Scholar
86.Suppes, T, Webb, A, Paul, B et al. , Clinical outcome in a randomized 1-year trial of clozapine versus treatment as usual for patients with treatment-resistant illness and a history of mania. Am J Psychiatry. 1999;156(8):1164–1169.CrossRefGoogle Scholar
87.Ghaemi, SN, Sachs, GS. Long-term risperidone treatment in bipolar disorder: 6-month follow up. Int Clin Psychopharmacol. 1997;12(6):333–338.CrossRefGoogle ScholarPubMed
88.Vieta, E, Gasto, C, Colom, F et al. , Role of risperidone in bipolar II: an open 6-month study. J Affect Disonl. 2001;67(1–3):213–219.CrossRefGoogle Scholar
89.Sharma, V, Persad, E, Mazmanian, D et al. , Treatment of rapid cycling bipolar disorder with combination therapy of valproate and lithium. Can J Psychiatry. 1993;38(2):137–139.CrossRefGoogle ScholarPubMed
90.Solomon, DA, Ryan, CE, Keitner, GI et al. , A pilot study of lithium carbonate plus divalproex sodium for the continuation and maintenance treatment of patients with bipolar I disorder. J Clin Psychiatry. 1997;58(3):95–99.CrossRefGoogle ScholarPubMed
91.Peselow, ED, Reve, RR, Difiglia, C et al. , Lithium prophylaxis of bipolar illness. The value of combination treatment. Br J Psychiatry. 1994;164(2):208–214.CrossRefGoogle ScholarPubMed
92.Denicoff, KD, Smith-Jackson, EE, Disney, ER et al. , Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in bipolar disorder. J Clin Psychiatry. 1997;58(11):470–478.CrossRefGoogle ScholarPubMed
93.Tohen, M, Chengappa, KNR, Suppes, T et al. , Relapse prevention in bipolar I disorder 18-month comparison of olanzapine plus mood stabiliser v. mood stabiliser alone. Br J Psychiatry. 2004;184:337–345.CrossRefGoogle ScholarPubMed