Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-20T04:30:51.007Z Has data issue: false hasContentIssue false
  • English
  • Français

When should mood stabilizers be withdrawn due to lack of efficacy? Some methodological considerations

Published online by Cambridge University Press:  16 April 2020

A. Murru ,
F. Colom ,
A. Nivoli ,
I. Pacchiarotti ,
M. Valenti  and
E. Vieta
A. Murru
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain
F. Colom
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain
A. Nivoli
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain
I. Pacchiarotti
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain
M. Valenti
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain
E. Vieta*
Affiliation:
Bipolar Disorders Program, Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036Barcelona, Spain
*
*Corresponding author. E-mail address: [email protected] (E. Vieta).
Get access

Abstract

Maintenance therapy in bipolar disorder is primarily aimed at preventing recurrence of acute episodes. Clinicians often decide on the basis of their own experience whether mood stabilizer (MS) is properly satisfying the objective of preventing a relapse/recurrence. Evidence-based data seem far from clinical practice in assessing a MS efficacy, as they mainly focus on a drug's efficacy to first relapse and not considering the patient's course of illness. The problem of assessing MS's efficacy seems further complicated when considering combination therapy, which, due to lack of evidence-based data, economical aspects, attitude of clinicians and legal issues may bring to cumulative prescriptions. Nowadays, the drug therapy for a bipolar patient is usually tailored after longitudinal observation of his specific course of illness. The course of illness should be considered also when choosing practical criteria for the suspension of a MS due to lack of efficacy. The authors propose some preliminary criteria which may help clinicians evaluating whether a mood stabilizer is being useful or not, dividing possible outcomes and suggesting subsequent therapeutic steps in the optimization of a patient's treatment.

Keywords

Bipolar disorderLack of efficacyMood stabilizerMaintenance treatment
Type
Review
Information
European Psychiatry , Volume 26 , Issue 3 , April 2011 , pp. 183 - 186
Copyright
Copyright © Elsevier Masson SAS 2011

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

Baldessarini, R, Henk, H, Sklar, A, Chang, J, Leahy, LPsychotropic medications for patients with bipolar disorder in the United States: polytherapy and adherence. Psychiatr Serv 2008;59 10:1175–1183.Google ScholarPubMed
Baldessarini, RJ, Tondo, L, Davis, P, Pompili, M, Goodwin, FK, Hennen, JDecreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review. Bipolar Disord 2006;8 5: Pt 2625–639.10.1111/j.1399-5618.2006.00344.xCrossRefGoogle ScholarPubMed
Corbella, B, Vieta, EMolecular targets of lithium action. Acta Neuropsychiatrica 2003; 15: 316–340.Google ScholarPubMed
Endicott, J, Rajagopalan, K, Minkwitz, M, Mcfadden, WBOLDER Study Group A randomized, double-blind, placebo-controlled study of quetiapine in the treatment of bipolar I and II depression: improvements in quality of life. Int Clin Psychopharmacol 2007;22:(1)29–37.Google ScholarPubMed
Goodwin, FK, Jamison, KManic-Depressive Illness. Bipolar disorders and recurrent depression. 2nd Ed. 2007 Oxford PressGoogle Scholar
Goodwin, GConsensus Group of the British Association for Psychopharmacology Evidence-based guidelines for treating bipolar disorder: revised second edition--recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2009;23:(4)346–388.Google ScholarPubMed
Goodwin, GM, Anderson, I, Arango, C, Bowden, CL, Henry, C, Mitchell, PB, et al.ECNP consensus meeting. Bipolar depression. Nice, March 2007. Eur Neuropsychopharmacol 2008;18(7:)535–549.CrossRefGoogle ScholarPubMed
Gould, TD, Quiroz, JA, Singh, J, Zarate, CA, Manji, HKEmerging experimental therapeutics for bipolar disorder: insights from the molecular and cellular actions of current mood stabilizers. Mol Psychiatry 2004; 9: 734–755.Google ScholarPubMed
Grunze, H, Vieta, E, Goodwin, GM, Bowden, C, Licht, RW, Moller, HJ, et al.The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania. World J Biol Psychiatry 2009;10(2):85–116.10.1080/15622970902823202CrossRefGoogle ScholarPubMed
Kasper, S, Calabrese, JR, Johnson, G, Tajima, O, Vieta, E, Viguera, AC, et al.International Consensus Group on the Evidence-based Pharmacological Treatment of Bipolar I and II Depression. J Clin Psychiatry 2008; 69: 1632–1646.Google Scholar
Leverich, GS, Post, RMLife charting the course of bipolar disorder. Curr Rev Mood Anxiety Disord 1996; 1: 48–61.Google Scholar
Mistler, LA, Mellman, TA, Drake, REA pilot study testing a medication algorithm to reduce polypharmacy. Qual Saf Health Care 2009;18(1):55–58.10.1136/qshc.2007.024471CrossRefGoogle ScholarPubMed
NICE clinical guidelines 38. Bipolar disorder. The management of bipolar disorder in adults, children and adolescents, in primary and secondary care. National Institute for Health and Clinical Excellence. 2009 update.Google Scholar
Post, RM, Denicoff, KD, Leverich, GS, Altshuler, LL, Frye, MA, Suppes, TM, et al.Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. J Clin Psychiatry 2003; 64: 680–690.Google ScholarPubMed
Rapoport, SI, Bosetti, FDo lithium and anticonvulsants target the brain arachidonic acid cascade in bipolar disorder? Arch Gen Psychiatry 2002; 59: 592–596.10.1001/archpsyc.59.7.592CrossRefGoogle ScholarPubMed
Schumock, GT, Walton, SM, Park, HY, Nutescu, EA, Blackburn, JC, Finley, JM, et al.Factors that influence prescribing decisions. Ann Pharmacother 2004; 38: 557–562.10.1345/aph.1D390CrossRefGoogle ScholarPubMed
Serretti, A, Artioli, PPredicting response to lithium in mood disorders: role of genetic polymorphisms. Am J Pharmacogenomics. 2003;3(1):17–30.10.2165/00129785-200303010-00004CrossRefGoogle ScholarPubMed
Suppes, T, Dennehy, EB, Hirschfeld, RM, Altshuler, LL, Bowden, CL, Calabrese, JR, et al.Texas Consensus Conference Panel on Medication Treatment of Bipolar Disorder The Texas implementation of medication algorithms: update to the algorithms for treatment of bipolar I disorder. J Clin Psychiatry 2005;66(7):870–886.Google ScholarPubMed
Swann, AC, Bowden, CL, Calabrese, JR, Dilsaver, SC, Morris, DDDifferential effect of number of previous episodes of affective disorder on response to lithium or divalproex in acute mania. Am J Psychiatry 1999;156(8):1264–1266.Google ScholarPubMed
Tohen, M, Frank, E, Bowden, CL, Colom, F, Ghaemi, SN, Yatham, LN, et al.The International Society of Bipolar Disorders (ISBD) Task Force on the Nomenclature of Course and Outcome in Bipolar Disorders. Bipolar Disord 2009;11(5):453–473.10.1111/j.1399-5618.2009.00726.xCrossRefGoogle ScholarPubMed
Vieta, E, Cruz, N, García-Campayo, J, de Arce, R, Manuel Crespo, J, Vallès, V, et al.A double-blind, randomized, placebo-controlled prophylaxis trial of oxcarbazepine as adjunctive treatment to lithium in the long-term treatment of bipolar I and II disorder. Int J Neuropsychopharmacol 2008;11(4):445–452.10.1017/S1461145708008596CrossRefGoogle ScholarPubMed
Yatham, LN, Kennedy, SH, Schaffer, A, Parikh, SV, Beaulieu, S, O’Donovan, C, et al.Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disord 2009;11(3):225–255.Google ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.