Treatment of bipolar disorder: a systematic review of available data

Background

The current article is a systematic review of the data available concerning the treatment of bipolar disorder.

Materials and methods

A systematic MEDLINE search concerning treatment guidelines and clinical trials.

Results

The search for treatment guidelines returned 370 articles and was last performed in March 1st, 2007. Thirty-three papers concerning treatment algorithms were traced and 115 trials that considered of importance for the aims of the current review:

Analysis of results: The literature suggests that lithium is useful during all phases of bipolar illness and it has a specific effectiveness on suicide prevention. Both first and second generation antipsychotics are efficacious in the treatment of acute mania. Quetiapine and olanzapine are also effective for treating bipolar depression. Anticonvulsants, particularly valproate and carbamazepine have antimanic properties, whereas lamotrigine may be preferably effective in the treatment of depression but not mania. Antidepressants should always be used in combination with an antimanic agent, because they may induce switching to mania or hypomania, mixed episodes and rapid cycling. The first line of psychosocial intervention in BD is psychoeducation, family-focused psychoeducation, and cognitive-behavioral therapy. Electroconvulsive therapy and transcranial magnetic stimulation are options for refractory patients.

Conclusions

Although a variety of treatment options for bipolar disorder are available today, their effectiveness is far from satisfactory, especially against bipolar depression. Combination techniques might improve the outcome; however there is still lack of data in this field. Research in this field is necessary as well as the development of better guidelines for step-by-step combination treatment.