Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Introduction
- 1 Bipolar disorder in historical perspective
- 2 The bipolar spectrum
- 3 Defining and measuring Bipolar II Disorder
- 4 Bipolar II Disorder in context: epidemiology, disability and economic burden
- 5 Is Bipolar II Disorder increasing in prevalence?
- 6 The neurobiology of Bipolar II Disorder
- 7 The role of antidepressants in managing Bipolar II Disorder
- 8 The use of SSRIs as mood stabilisers for Bipolar II Disorder
- 9 Mood stabilisers in the treatment of Bipolar II Disorder
- 10 The use of atypical antipsychotic drugs in Bipolar II Disorder
- 11 The role of fish oil in managing Bipolar II Disorder
- 12 The role of psychological interventions in managing Bipolar II Disorder
- 13 The role of wellbeing plans in managing Bipolar II Disorder
- 14 Survival strategies for managing and prospering with Bipolar II Disorder
- 15 A clinical model for managing Bipolar II Disorder
- 16 Management commentary
- 17 Management commentary
- 18 Management commentary
- 19 Management commentary
- 20 Management commentary
- 21 Management commentary
- 22 Management commentary
- 23 Management commentary
- 24 Management commentary
- 25 Management commentary
- 26 Management commentary: What would Hippocrates do?
- 27 Management commentary
- 28 Rounding up and tying down
- Appendix 1 Black Dog Institute Self-test for Bipolar Disorder: The Mood Swings Questionnaire
- Index
- References
9 - Mood stabilisers in the treatment of Bipolar II Disorder
Published online by Cambridge University Press: 13 August 2009
Edited by
Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Introduction
- 1 Bipolar disorder in historical perspective
- 2 The bipolar spectrum
- 3 Defining and measuring Bipolar II Disorder
- 4 Bipolar II Disorder in context: epidemiology, disability and economic burden
- 5 Is Bipolar II Disorder increasing in prevalence?
- 6 The neurobiology of Bipolar II Disorder
- 7 The role of antidepressants in managing Bipolar II Disorder
- 8 The use of SSRIs as mood stabilisers for Bipolar II Disorder
- 9 Mood stabilisers in the treatment of Bipolar II Disorder
- 10 The use of atypical antipsychotic drugs in Bipolar II Disorder
- 11 The role of fish oil in managing Bipolar II Disorder
- 12 The role of psychological interventions in managing Bipolar II Disorder
- 13 The role of wellbeing plans in managing Bipolar II Disorder
- 14 Survival strategies for managing and prospering with Bipolar II Disorder
- 15 A clinical model for managing Bipolar II Disorder
- 16 Management commentary
- 17 Management commentary
- 18 Management commentary
- 19 Management commentary
- 20 Management commentary
- 21 Management commentary
- 22 Management commentary
- 23 Management commentary
- 24 Management commentary
- 25 Management commentary
- 26 Management commentary: What would Hippocrates do?
- 27 Management commentary
- 28 Rounding up and tying down
- Appendix 1 Black Dog Institute Self-test for Bipolar Disorder: The Mood Swings Questionnaire
- Index
- References
Summary
Introduction
We first raise two questions. Are mood stabilisers underused in the treatment of patients with Bipolar II Disorder (BP II)? Secondly, and perhaps more centrally, do all BP II patients need to be treated with mood stabilisers?
While mood stabilisers are integral to the evidence-based management of Bipolar I Disorder (BP I), there are no large, well-designed, controlled trials specifically tailored to help guide treatment decisions about mood stabilisers for BP II patients – and so there are no definitive answers to these questions. Despite this dearth of data to guide therapy, clinicians often rely on mood stabilisers when treating patients with BP II. For instance, a study describing prescription patterns for 500 bipolar patients in a US psychiatric academic setting showed that lithium and anticonvulsants play a prominent role in the treatment of BP II patients referred from the community (Ghaemi et al., 2006a). Lithium was prescribed in 36% of that sample, while 30% had been treated with valproate or carbamazepine, and 34% had received second-generation anticonvulsants such as lamotrigine, topiramate or gabapentin (Bauer and Mitchner, 2004; Ghaemi et al., 2006a).
In this chapter we review the evidence for lithium and anticonvulsants specifically for the treatment of BP II Disorder. Though we consider studies that included both BP I and BP II conditions, those studies reporting separate results for BP II are highlighted.
- Type
- Chapter
- Information
- Bipolar II DisorderModelling, Measuring and Managing, pp. 120 - 132Publisher: Cambridge University PressPrint publication year: 2008
References
and (2000). Does lithium therapy still work? Evidence of stable responses over three decades. Archives of General Psychiatry, 57, 187–90.CrossRefGoogle ScholarPubMed
, , and (1998). Effects of rapid cycling on response to lithium maintenance treatment in 360 Bipolar I and II disorder patients. Journal of Affective Disorders, 155, 1434–6.Google Scholar
, and (2001). Treating the suicidal patient with bipolar disorder: reducing suicide risk with lithium. Annals of the New York Academy of Sciences, 932, 24–38.CrossRefGoogle ScholarPubMed
and (2004). What is a ‘mood stabilizer’? An evidence-based response. American Journal of Psychiatry, 161, 3–18.CrossRefGoogle Scholar
(2005). Bipolar disorder and substance abuse. Psychiatric Clinics of North America, 28, 415–25.CrossRefGoogle ScholarPubMed
, , , and (2003). Lamotrigine in patients with bipolar disorder and cocaine dependence. Journal of Clinical Psychiatry, 64, 197–201.CrossRefGoogle ScholarPubMed
, , et al. (1999). Spectrum of activity of lamotrigine in treatment-refractory bipolar disorder. American Journal of Psychiatry, 156, 1019–23.Google ScholarPubMed
, , et al. (2005). A 20-month, double-blind, maintenance trial of lithium versus divalproex in rapid-cycling bipolar disorder. American Journal of Psychiatry, 162, 2152–61.CrossRefGoogle ScholarPubMed
, , et al. (2000). A double-blind, placebo-controlled, prophylaxis study of lamotrigine in rapid-cycling bipolar disorder. Lamictal 614 Study Group. Journal of Clinical Psychiatry, 61, 841–50.CrossRefGoogle ScholarPubMed
and (2005). Lithium – a continuing story in the treatment of bipolar disorder. Acta Psychiatrica Scandinavica, 111 (Suppl. 426), S7–12.CrossRefGoogle Scholar
, and (1982). Prophylaxis with lithium carbonate: an update. Archives of General Psychiatry, 39, 1344–5.Google ScholarPubMed
, and (1976). Lithium prophylaxis of depression in Bipolar I, Bipolar II, and unipolar patients. American Journal of Psychiatry, 133, 925–9.Google ScholarPubMed
and (2002). Divalproex sodium treatment of women with Borderline Personality Disorder and Bipolar II: a double-blind placebo-controlled pilot study. Journal of Clinical Psychiatry, 63, 442–6.CrossRefGoogle ScholarPubMed
, , et al. (2000). A placebo-controlled study of lamotrigine and gabapentin monotherapy in refractory mood disorders. Journal of Clinical Psychopharmacology, 20, 607–14.CrossRefGoogle ScholarPubMed
and (2001). Gabapentin treatment of the non-refractory bipolar spectrum: an open case series. Journal of Affective Disorders, 65, 167–71.CrossRefGoogle Scholar
, , and (1998). Gabapentin treatment of mood disorders: a preliminary study. Journal of Clinical Psychiatry, 59, 426–9.CrossRefGoogle ScholarPubMed
, , et al. (2006a). Pharmacological treatment patterns at study entry for the first 500 STEP-BD participants. Psychiatric Services, 57, 660–5.CrossRefGoogle Scholar
, , et al. (2006b). Long-term lamotrigine plus lithium for bipolar disorder: one year outcome. Journal of Psychiatric Practice, 12, 300–5.CrossRefGoogle Scholar
GlaxoSmithKline (2006). A multicenter, double-blind, placebo-controlled, fixed-dose, eight-week evaluation of the efficacy and safety of lamotrigine in the treatment of major depression in patients with Type II bipolar disorder. http://ctr.gsk.co.uk.
, , et al. (2003). Suicide risk in bipolar disorder during treatment with lithium and divalproex. Journal of the American Medical Association, 290, 1467–73.CrossRefGoogle ScholarPubMed
and (1999). Lithium versus carbamazepine in the maintenance treatment of Bipolar II Disorder and Bipolar Disorder Not Otherwise Specified. International Clinical Psychopharmacology, 14, 283–5.CrossRefGoogle Scholar
and (2004). Bipolar II Disorder: an overview of recent developments. Canadian Journal of Psychiatry, 49, 802–12.CrossRefGoogle ScholarPubMed
(1993). Low-dose valproate: a new treatment for cyclothymia, mild rapid-cycling disorders, and premenstrual syndrome. Journal of Clinical Psychiatry, 54, 229–34.Google ScholarPubMed
, , et al. (2003). A prospective investigation of the natural history of the long-term weekly symptomatic status of Bipolar II Disorder. Archives of General Psychiatry, 60, 261–9.CrossRefGoogle ScholarPubMed
, , et al. (2005). Psychosocial disability in the course of Bipolar I and II Disorders. A prospective, comparative, longitudinal study. Archives of General Psychiatry, 62, 1322–30.CrossRefGoogle ScholarPubMed
, , et al. (1982). Lithium carbonate and imipramine in the prophylaxis of unipolar and Bipolar II illness: a prospective, placebo-controlled comparison. Archives of General Psychiatry, 39, 1065–9.CrossRefGoogle ScholarPubMed
and (2000). Differential efficacy of lithium and carbamazepine in the prophylaxis of bipolar disorder: results of the MAP study. Neuropsychobiology, 42 (Suppl. 1), S2–10.CrossRefGoogle ScholarPubMed
, , and (2005). Mood stabilizers: a labile label. Acta Psychiatrica Scandinavica, 111 (Suppl. 426), S5–6.CrossRefGoogle Scholar
, , and (2003). Hypomania induced by adjunctive lamotrigine. American Journal of Psychiatry, 160, 183–4.CrossRefGoogle ScholarPubMed
, , et al. (2002). Topiramate versus bupropion SR when added to mood stabilizer therapy for the depressive phase of bipolar disorder: a preliminary single-blind study. Bipolar Disorders, 4, 207–13.CrossRefGoogle ScholarPubMed
, and (2005). Open-label adjunctive topiramate in the treatment of unstable bipolar disorder. Canadian Journal of Psychiatry, 50, 415–22.CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (NICE) (2006). Bipolar disorder. NICE clinical guideline 38. http://www.nice.org.uk.
, , et al. (2001). Double-blind, placebo-controlled comparison of imipramine and paroxetine in the treatment of bipolar depression. American Journal of Psychiatry, 158, 906–12.CrossRefGoogle ScholarPubMed
, , et al. and STEP-BD Investigators (2006). Treatment-resistant bipolar depression: a STEP-BD equipoise randomized effectiveness trial of antidepressant augmentation with lamotrigine, inositol, or risperidone. American Journal of Psychiatry, 163, 210–16.CrossRefGoogle ScholarPubMed
, , , and (1978). Prophylactic effect of lithium and imipramine in unipolar and Bipolar II patients: a preliminary report. American Journal of Psychiatry, 135, 570–2.Google ScholarPubMed
, and (2006). Effects of lamotrigine in patients with bipolar disorder and alcohol dependence. Bipolar Disorders, 8, 289–93.CrossRefGoogle ScholarPubMed
, and (2006). Randomised, double-blind pilot trial comparing lamotrigine versus citalopram for the treatment of bipolar depression. Journal of Affective Disorders, 96, 95–9.CrossRefGoogle Scholar
, , et al. (1999). Lamotrigine for the treatment of bipolar disorder: a clinical case series. Journal of Affective Disorders, 53, 95–8.CrossRefGoogle ScholarPubMed
(2005). Bipolar depression: issues in diagnosis and treatment. Harvard Review of Psychiatry, 13, 257–71.CrossRefGoogle ScholarPubMed
, and (2001). Long-term clinical effectiveness of lithium maintenance treatment in Types I and II bipolar disorders. British Journal of Psychiatry, 41 (Suppl. 178), S184–90.CrossRefGoogle ScholarPubMed
, , and (1998). Lithium maintenance treatment of depression and mania in Bipolar I and Bipolar II disorders. American Journal of Psychiatry, 155, 638–45.CrossRefGoogle ScholarPubMed
van der Loos, M., Nolen, W. A. and Vieta, E. (2006). Lamotrigine as add-on to lithium in bipolar depression. Paper presented at the fifth European Stanley Conference on Bipolar Disorder, Barcelona, 5–7 October.
, , et al. (2003). Adjunctive topiramate in Bipolar II Disorder. World Journal of Biological Psychiatry, 4, 172–6.CrossRefGoogle ScholarPubMed
, , et al. (2006). A double-blind, randomized, placebo-controlled, prophylaxis study of adjunctive gabapentin for bipolar disorder. Journal of Clinical Psychiatry, 67, 473–7.CrossRefGoogle ScholarPubMed
, , and (2001). Divalproex therapy in medication-naïve and mood-stabilizer-naïve Bipolar II depression. Journal of Affective Disorders, 67, 207–12.CrossRefGoogle ScholarPubMed
(2004). Diagnosis and management of patients with Bipolar II Disorder. Journal of Clinical Psychiatry, 66 (Suppl. 1), S13–17.Google Scholar
, , et al. (2005). Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: Consensus and controversies. Bipolar Disorders, 7 (Suppl. 3), S5–69.CrossRefGoogle ScholarPubMed
, , et al. (1999). Gabapentin as an adjunctive treatment in bipolar disorder. Journal of Affective Disorders, 55, 73–7.CrossRefGoogle ScholarPubMed
, and (2000). Double-blind comparison of addition of a second mood stabilizer versus an antidepressant to an initial mood stabilizer for treatment of patients with bipolar depression. American Journal of Psychiatry, 157, 124–6.CrossRefGoogle Scholar
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