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9 - Mood stabilisers in the treatment of Bipolar II Disorder

Published online by Cambridge University Press:  13 August 2009

By
George Hadjipavlou  and
Lakshmi N. Yatham
Edited by
Gordon Parker
George Hadjipavlou
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, Canada
Lakshmi N. Yatham
Affiliation:
Mood Disorders Centre, University of British Columbia, Vancouver, Canada
Gordon Parker
Affiliation:
University of New South Wales, Sydney
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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 Disorder
Modelling, Measuring and Managing
 , pp. 120 - 132
Publisher: Cambridge University Press
Print publication year: 2008

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