Abstract:
Background
Bipolar disorder is a chronic recurrent neuropsychiatric
disorder. The management of the different phases
of the illness requires different combinations of
medicines and other treatment strategies.
Aims
To synthesize the current evidence for management
of bipolar disorder.
Methods
We searched the MEDLINE, Cochrane database of
systematic reviews and the Database of Abstracts
of Reviews of Effects (DARE) for recent systematic
reviews and meta-analysis between 1995 and 2010.
Original articles of relevant randomised controlled
trials (RCT) were accessed.
Results and conclusions
For treatment of acute mania lithium, valproate and
carbamazepine are more effective than placebo but
they have no superiority over antipsychotics. There is evidence from RCTs that second generation
antipsychotics (SGA) are more effective than
placebo. Haloperidol may be more effective than
SGA in treatment of acute mania. Combination of
antipsychotic and mood stabiliser is more effective
than mood stabiliser monotherapy alone.
In treatment of acute bipolar depression the
current evidence is inadequate to support the use
of lithium as monotherapy. The most effective
treatment is combination of a mood stabiliser and an
antidepressant which also minimises manic switches.
FDA has approved olanzapine-fluoxetine combination
and quetiapine monotherapy. Lamotrigine is also
effective in the treatment of acute bipolar depression.
For prophylaxis lithium, valproate and carbamazepine
are effective while lamotrigine is primarily effective
in preventing depressive episodes. Lithium is more
effective in preventing manic than depressive
episodes. Evidence for efficacy of antipsychotics in
prophylaxis is limited.
