Long-term Treatment in Bipolar Disorder

Year 2010, Volume: 2 Issue: 2, 206 - 236, 01.06.2010

Meliha Zengin Eroğlu Nurgül Özpoyraz

Abstract

Although the importance of long-term prophylactic treatment is certain in bipolar disorder, there is stil debate on how to which patients and evaluate the treatment response. Efficacious long-term treatment can reduce morbidity and mortality significantly and improve quality of life of bipolar patients. The concept of ideal response should also be defined very clearly in order to discuss the difficulties of measuring the effectiveness of the prophylactic treatment. The aims of this paper are to determine whether our currently methods and criteria are valid, reliable and sensitive evaluating the efficacy of the treatment response and to briefly inform the clinicians about the drugs used in pharmacologic prophylaxis in accordance with relevant data.

Keywords

Bipolar Disorder, Long-term, Treatment, Maintenance, Prophylaxis

Bipolar Bozuklukta Koruyucu Tedavi

Abstract

Bipolar bozuklukta uzun dönemde koruyucu tedavinin öneminin tartışılmazlığına rağmen bunun nasıl yapılacağı ve tedavi yanıtının nasıl değerlendirileceğiyle ilgili tartışmalar sürüp gitmektedir. Etkin bir koruyucu tedavi mortalite ve morbiditeyi düşürür ve hastaların yaşam kalitesini önemli ölçüde artırır. Koruyucu tedavinin etkinliğini ölçerken aynı zamanda hastalık seyriyle ilişkili olan ideal yanıt kavramı da açık olarak tanımlanmalıdır. Bu yazıda günümüzde koruyucu sağaltımın etkinliğini belirleyen geçerli, güvenilir, duyarlı ölçütlerimiz ve yöntemlerimizin olup olmadığının değerlendirilmesi ve sunulan veriler çerçevesinde klinisyenlerin farmakolojik korumada kullanılan ilaçlar hakkında genel olarak bilgilendirilmesi amaçlanmıştır.

Keywords

Bipolar Bozukluk, Koruyucu Tedavi, Uzun Dönem, Tedavi

References

• Angst J, Sellaro R.. Historical perspectives and natural history of bipolar disorder. Biol Psychiatry 2000; 48:445-457.
• KesslerRC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S et al. Lifetime and 12-month prevalence of DSM-III-R Psychiatric disorders in the United States. Arch Gen Psychiatry 1994; 51:8-19.
• Angst J. The emerging epidemiology of hypomania and bipolar II disorder. J Affect Disord 1998; 50:143-151.
• Szadoczky E, Papp Z, Vitrai J, Rihmer Z, Furedi J. The prevalence of major depressive and bipolar disorders in Hungary J Affect Disord 1998; 50:153-162.
• Akiskal HS, Bourgeois ML, Angst J , Post R, Möller H, Hirschfeld R. Re-evaluating the prevalance of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord 2000; 59:5-30.
• Bebbington P, Ramana R. The epidemiology of bipolar disorder. Soc Psychiatry Psychiatr Epid 1995; 30:279-292.
• Kessler RC, Rubinow DR, Holmes C. The epidemiology of DSM III-R Bipolar I disorder in a general population survey. Psychol Med 1997; 27:1079-1089.
• Akiskal HS. Classification, diagnosis and boundaries of bipolar disorders: A review. In Bipolar Disorders. WPA Series Evidence and Experience in Psychiatry (Eds M Maj, HS Akiskal, JJ López-Ibor, N Sartorius): 1-50. Chichester, Wiley, 2002.
• Luborsky L. Clinicians’ judgements mental health. Arch Gen Psychiatry 1962; 7:407
• Begeley CE, Annegers JF, Swann AC, Lewis C, Coan S, Schnapp WB et al. The lifetime cost of bipolar disorder in the United States: an estimate based on incidence and course of illness. Pharmacoeconomics 2001; 19:483-495.
• Simpson SG, Jamison KR. The risk of suicide in patients with bipolar disorders. J Clin Psychiatry 1999; 60(suppl 2):53-56.
• Brady KT, Sone SC. The relationship between substance abuse and mood disorder. J Clin Psychiatry 1995; 56(suppl 3):19-24.
• Coppen A, Noguera R, Bailey J, Burns BH, Swani MS, Hare EH et al. Prophylactic lithium in affective disorders: Controlled trial. Lancet 1972; 2:275-279.
• Hullin RP, McDonald R, Allsopp MNE. Prophylactic lithium in recurrent disorders. Lancet 1972; 1:1044-1046.
• Angst J. Comorbidity of mood disorders: A longitudinal prospective study. Br J Psychiatry 1996; 30:31-71.
• Simon GE, Unutzer J. Health care utilization and costs among patients treated for bipolar disorder in an insured population. Psychiatr Serv 1999; 50:1303-1308.
• Wyatt RJ, Henter I. An economic evaluation of manic-depressive illness: 1991. Soc Psychiatry Epidemiol 1995; 30:213-219.
• Montgomery SA, Cassano G. Management of Bipolar Disorder. Londra, Martin Dunitz Ltd, 1996.
• Consensus Development Panel: NIMH/NIH Consensus Development Conference Statement. Mood Disorders: Pharmacologic prevention of recurrence. Am J Psychiatry 1985; 142:469-476.
• WHO Mental Health Colloborating Centres. Pharmacotherapy of depressive disorders: A consensus statement. J Affect Disord 1989; 17:197-198.
• Goodwin FK, Jamison KR. Manic-Depressive Illness. New York, Oxford University, 1990.
• American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry 2002; 159:1–50.
• Vahip S, Yazıcı O, Oral T. İki Uçlu Duygudurum Bozuklukları Tedavi Kılavuzu, 1.baskı. İstanbul, Türkiye Psikiyatri Derneği, 2003.
• Goodwin GM. Evidence-based guidelines for treating bipolar disorder: Recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2003; 17:149-173.
• Yatham LN, Kennedy SH, O’Donovan C, Parikh S, MacQueen G, McIntyre R et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder:consensus and controversies. Bipolar Disorders 2005; 7(suppl 3):5-69.
• National Institute for Health and Clinical Excellence (NICE). The management of bipolar disorder in adults, children and adolescents in primary and secondary care. National Clinical Practice Guideline Number 38. London, British Psychological Study and Gaskell, 2006.
• Goodnick PJ. Predictors of Treatment Response in Mood Disorders. Washington DC, American Psychiatric Press, 1996.
• Colom F, Vieta E, Martínez-Arán A, Reinares M, Benabarre A, Gastó C. Clinical factors associated with treatment noncompliance in euthymic bipolar patients. J Clin Psychiatry 2000; 61:549-555.
• Schumann C, Lenz G, Berghöfer A, Müller-Oerlinghausen B. Non-adherence with long-term prophylaxis: a 6-year naturalistic follow-up study of affectively ill patients. Psychiatry Res 1999; 89:247-257.
• Prien RF, Potter WZ. NIMH workshop report on treatment of bipolar disorder. Psychopharmacology Bull 1990; 26:409-427.
• Rybakowski JK, Chlopocka-Wozniak M, Suwalska A.The prophylactic effect of long- term lithium administration in bipolar patients entering treatment in the 1970s and 1980s. Bipolar Disord 2001; 3:63-67.
• Nierenberg AA, Ostacher MJ, Borrelli DJ, Iosifescu DV, Perlis RH, Desrosiers A et al. The integration of measurement and management for the treatment of bipolar disorder: A STEP-BD model of collaborative care in psychiatry. J Clin Psychiatry 2006; 67(suppl 11):3-7.
• Vahip S. Koruyucu tedavide yanıtın belirlenebilirliği üzerine. Psikiyatri Psikoloji Psikofarmakoloji (3P) Dergisi 2000; 8(ek 2):19-22.
• Bowden CL, Calabrase JR, McElroy SL, Gyulai L, Waasef A, Petty F et al. A randomized, placebo-contolled 12- month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintanence Study Group. Arch Gen Psychiatry 2000; 57:481-489.
• Ghaemi SN, Boiman EE, Goodwin FK. Kindling and second messengers:an approach to the neurobiology of recurrence in bipolar disorder. Biol Psychiatry 1999; 45:137
• Solomon DA, Keitner GI, Miller IW, Shea MT, Keller MB. Course of illness and maintenance treatments for patient with bipolar disorder. J Clin Psychiatry 1995; 56:5-13.
• Baldessarini RJ, Tondo L, Hennen J, Floris G. Latency and episodes before treatment: response to lithium maintenance in bipolar I and II disorders. Bipolar Disord 1999; 2:91-97.
• Viguera AC, Baldessarini RJ, Tondo L. Response to lithium treatment in bipolar disorders:comparison of women and men. Bipolar Disord 2001; 3:245-252.
• Grof P, Duffy A, Cavazzoni P, Grof E, Garnham J, MacDougall M et al. Is response to prophylactic lithium a familial trait? J Clin Psychiatry 2002; 63:942-947.
• Sachs GS. Treatment-resistant bipolar depression. Psychiatr Clin North Am 1996; 19:215-236.
• Goodwin GM, Young AH. The British Association for Psychopharmacology guidelines for treatment of bipolar disorder: a summary. J Psychopharmacol 2003; 17(suppl 4):3-6.
• Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA et al. The long- term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen
• Schou M. Lithium treatment at 52. J Affect Disord 2001; 67:21-32.
• Jefferson JM, Greist JH. Lithium. In Comprehensive Textbook of Psychiatry (Eds BJ Sadock, V Sadock ): 2377-2390. Baltimore, USA, Lippincott William Wilkins, 2000.
• Rapoport SI, Basselin M, Kim HW, Rao JS. Bipolar disorder and mechanisms of action of mood stabilizers. Brain Res Rev 2009; 61:185-209.
• Schou M. Fourty years of lithium treatment. Arch Gen Psychiatry 1997; 54:9-13.
• Maj M, Pirozzi R, Magliano L, Bartoli L. Long term outcome of lithium prophylaxis in bipolar disorder: A 5 year prospective study of 402 patients at a lithium clinic. Am J Psychiatry 1998; 155:30-35.
• Baastrup PC. The use of lithium in manic-depressive psychoses. Compr Psychiatry 1964; 5:396-408.
• Schou M, Baastrup PC. Lithium treatment of manic depressive disorder. Dosage and control. JAMA 1967; 201:696-698.
• Baastrup PC, Poulsen JC, Schou M, Thomsen K, Amdisen A. Prophylactic lithium: Double blind discontinuation in manic-depressive and recurrent depressive disorders. Lancet 1970; 2(7668):326-330.
• Melia PI. Prophylactic lithium: A double blind trial in recurrent affective disorders. Br J Psychiatry 1970; 116:621-624.
• Coppen A, Noguera R, Bailey J, Burns BH, Swani MS, Hare EH et al. Prophylactic lithium in affective disorders: Controlled trial. Lancet 1971; 2(7719):275-279.
• Prien RF, Caffey EM, Klett CJ. Prophylactic efficacy of lithium carbonate in manic depressive illness. Arch Gen Psychiatry 1973; 28:337-341.
• Suppes T, Baldessarini RJ, Faedda GL, Tohen M. Risk of recurrence following discontinuation of lithium treatment in bipolar disorder. Arch Gen Psychiatry 1991; 48:1082-1088.
• Keck PE Jr, Welge JA, Strakowski SM, Arnold LM, McElroy SL. Placebo effect in randomized controlled maintenance studies of patients with bipolar disorder. Biol Psychiatry 2000; 47:756-761.
• Kane JM, Quitkin FM, Rifkin A, Ramos-Lorenzi JR, Nayak DD, Howard A. Lithium carbonate and imipramine in the prophylaxis of unipolar and bipolar II illness: a prospective, placebo controlled comparison. Arch Gen Psychiatry 1982; 39:1065- 1069.
• Markar HR, Mander AJ. Efficacy of lithium prophylaxis in clinical practice. Br J Psychiatry 1989; 155:993-1000.
• Maj M, Pirozzi R, Magliano L. Late non-response to lithium prophylaxis in bipolar patients: Prevalence and predictors. J Affect Disord 1996; 39:39-42.
• Maj M. The effect of lithium in bipolar disorder: a review of recent research evidence. Bipolar Disord 2003; 5:180-188.
• Harrow M, Goldberg JF, Grossman LS, Meltzer HY. Outcome in manic disorders: A naturalistic follow up study. Arch Gen Psychiatry 1990; 47:665-671.
• Coryell W, Winokur G, Solomon D, Shea T, Leon A, Keller M. Lithium and recurrence in a long term follow up bipolar affective disorder. Psychol Med 1997; 27:281-289.
• Smith LA, Cornelius V, Warnock A, Bell A, Young AH. Effectiveness of mood stabilizers and antipsychotics in the maintenance phase of bipolar disorder: A systematic review of randomized controlled trials. Bipolar Disord 2007; 9;394-412.
• Sachs GS, Thase ME. Bipolar disorder therapeutics: Maintenance treatment. Biol
• Dunner DL, Fleiss JL, Fieve RR. The course of development of mania in patients with current depression. Am J Psychiatry 1976; 133:905-908.
• Glen AI, Johnson AL, Shepherd M. Continuation therapy with lithium and amitriptyline in unipolar depressive illness: A randomized, double blind controlled trial. Psychol Med 1984; 14:37-50.
• Prien RF. NIMH report. Five center study clarifies use of lithium imipramine for reccurent affective disorders. Hosp Community Psychiatry 1984; 35:1097-1098.
• Prien RF, Kupfer DJ, Mansky PA, Small JG, Tuason VB, Voss CB et al. Drug therapy in the prevention of reccurences in unipolar and bipolar affective disorders. Report of the NIMH Collaborative Study Group comparing lithium carbonate, imipramine and a lithium carbonate-imipramine combination. Arch Gen Psychiatry 1984; 41:1096- 1104.
• Bowden CL, Calabrase JR, Sachs G, Yatham LN, Asghar SA, Hompland M et al. A placebo-controlled 18-month trial lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry 2003; 60:392-400.
• Calabrase JR, Bowden CL, Sachs G, Yatham LN, Behnke K, Mehtonen OP et al. A placebo-controlled 18-month trial lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. J Clin Psychiatry 2003; 64:1013- 1024.
• Calabrase JR, Goldberg JF, Ketter TA, Suppes T, Frye M, White R et al..Reccurence in bipolar I disorder: A post hoc analysis excluding relapses in two double-blind maintenance studies. Biol Psychiatry 2006; 59:1061-1064.
• Goodwin GM, Bowden CL, Calabrase JR, Grunze H, Kasper S, White R et al. A pooled analysis of 2 placebo-controlled 18-months trials lamotrigine and lithium maintenance in bipolar I disorder. J Clin Psychiatry 2004; 65:432-441.
• Kane JM, Quitkin FM, Rifkin A, Ramos-Lorenzi JR, Nayak DD, Howard A. Lithium carbonate and imipramine in the prophylaxis of unipolar and bipolar II illness: a prospective, placebo-controlled comparison. . Arch Gen Psychiatry 1982; 39:1065- 1069.
• Burgess S, Geddes J, Hawton K, Townsend E, Jamison K, Goodwin G. Lithium for maintenance treatment of mood disorders. Cochrane Database Syst Rev 2001; 3:CD003013.
• Geddes JR, Burgess S, Hawton K, Jamison K, Goodwin GM. Long-term lithium therapy for bipolar disorder: Systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry 2004; 161:217-222.
• Bowden CL, Calabrase JR, McElroy SL, Gyulai L, Wassef A, Petty F et al. Divalproeks maintenance study group:A randomized plasebo controlled 12 month trial of Divalproeks and lithium in treatment of outpatients with bipolar I disorder.Arch Gen Psychiatry 2000; 57:481-489.
• Calabrase JR, Bowden CL, DeVeaugh–Geiss J, Earl NL, Gyulai L, Sachs GS et al. Lamotrigine demonstrates long-term mood stabilization in manic patients in 2001. Psychiatric Association Annual Meeting. Washington DC, American Psychiatric Association, 2001; p110.
• Frye MA, Yatham LN, Calabrase JR, Bowden CL, Ketter TA, Suppes T et al. Incidence and time course of subsyndromal symptoms in patients with bipolar I disorder: An evaluation of 2 placebo-controlled maintenance trials. J Clin Psychiatry 2006; 67:1721-1728.
• Fieve RR, Kumbaraci T, Dunner DL. Lithium prophylaxis of depression in bipolar I, bipolar II and unipolar patients. Am J Psychiatry 1976; 133:925-929.
• Hullin RP, McDonald R, Allsopp MN. Prophylactic lithium in recurrent affective disorders. Lancet 1972; 1:1044-1046.
• Klein HE, Broucek B, Greil W. Lithium withdrawal triggers psychotic states. BrJ Psychiatry 1981; 139:255-256.
• Prien RF, Klett CJ, Caffey EM Jr. Lithium carbonate and imipramine in prevention of affective episodes: A comparison in recurrent affective illness. Arch Gen Psychiatry 1973; 29:420-425.
• Margo A, McMahon P. Lithium withdrawal triggers psychosis. Br J Psychiatry 1982; 141:407-410.
• Persson G. Lithium prophylaxis in affective disorders. Acta Psychiatr Scand 1972; 48:462-479.
• Mander AJ, Loudon JB. Rapid reccurence of mania following abrupt discontinuation of lithium. Lancet 1988; 2(8601):15-17.
• Baastrup PC, Poulsen JC, Schou M, Thomsen K, Admisen A. Prophylactic lithium: double blind discontinuation in manic-depressive disorders. Lancet 1970; 2(7668):326-330.
• Christodoulou GN, Lykouras EP. Abrupt lithium discontinuation in manic-depressive patients. Acta Psychiatr Scand 1982; 65:310-314.
• Cundall RL, Brooks PW, Murray LG. A controlled evaluation of lithium prophylaxis in affective disorders. Psychol Med 1972; 2:308-311.
• Hullin RP, McDonald R, Allsopp MN. Prophylactic lithium in recurrent affective disorders. Lancet 1972; 1(7759):1044-1046.
• Kafantaris V, Coletti DJ, Dicker R, Padula G, Pleak RR, Alvir JM. Lithium treatment of acute mania in adolescents: A placebo controlled discontinuation study. J Am Acad Child Adolesc Psychiatry 2004; 43:984-993.
• Small JG, Small IF, Moore DF. Experimental withdrawal of lithium in recovered manic- depressive patients: a report of five cases. Am J Psychiatry 1971; 127:1555-1558.
• Tohen M, Greil W, Calabrase JR, Sachs GS, Yatham LN, Oerlinghausen BM, et al. Olanzapine versus lithium in the maintenance treatment of bipolar disorder: a 12 month randomized double-blind controlled clinical trial. Am J Psychiatry 2003; 162:1281-1290.
• Calabrase JR, Shelton MD, Rapport DJ, Youngstorm EA, Jackson K, Bilali S et al. A 20- month, double-blind, maintenance trial of lithium versus divalproex in rapid-cycling bipolar disorder. Am J Psychiatry 2005; 162:2152-2161.
• Gyulai L, Bowden CL, McElroy SL, Calabrase JR, Petty F, Swann AC et al. Maintanence efficacy of divalproex in the prevention of bipolar depression. Neuropsychopharmacology 2003; 28:1374-1382.
• Post RM, Leverich GS, Althuler L, Mikalauskas K. Lithium-discontinuation-induced refractoriness. Am J Psychiatry 1992; 149:1727-1729.
• Baldessarini RJ, Tondo L. Reduced morbidity after gradual discontinuation of lithium treatment for bipolar II: A replication study. Am J Pschiatry 2000; 154:551-555.
• Suppes T, Baldessarini R, Faedda G, Tohen M. Risk of recurrence following discontinuation of lithium treatment in bipolar disorder. Arch Gen Psychiatry 1991; 48:1082-1088.
• Gelenberg AJ, Kane JM, Keller MB, Lavori P, Rosenbaum JF, Cole K et al. Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorder. N Engl J Med 1989; 321:1489-1493.
• Solomon DA, Ryan CE, Keitner GI. A pilot study of lithium carbonate plus divalproex sodium fort he continuation and maintenance treatment of patients with bipolar disorder. J Clin Psychiatry 1997; 58:95-99.
• Tondo L, Baldessarini RJ, Hennen J, Floris G. Lithium maintenance treatment: Depression and mania in bipolar I and II disorders. Am J Psychiatry 1998; 155:638
• Viguera AC, Baldessarini RJ, Tondo L. Response to lithium treatment in bipolar disorders:comparison of women and men. Bipolar Disord 2001; 3:245-252.
• Tondo L, Baldessarini RJ, Floris G. Long-term clinical effectiveness of lithium maintenance treatment in types I and II bipolar disorders. Br J Psychiatry 2001; 41(suppl): s184-s190.
• Shiloh R, Nutt D, Weizman A. Psikiyatrik Farmakoterapi Atlası (Çeviren. S Kırlı). İstan- bul, Yelkovan Yayıncılık, 2000.
• Pope HG, McElroy SL, Keck PE, Hudson JI. Valproate in the treatment of acute mania: A placebo controlled study. Arch Gen Psychiatry 1991; 48:62-68.
• Bowden CL, Brugger AM, Swann AC, Calabrese JR, Janicak PG, Petty F et al. Efficacy of divalproex vs lithium and placebo in the treatment of mania. The Depakote Mania Study Group. JAMA 1994; 271:918-924.
• Emrich HM, Wolf R. Valproate treatment of mania. Prog Neuropsychopharmacol Biol Psychiatry 1992; 16:691-701.
• Calabrase JR, Woyshville ML, Kimmel SE, Rapport DJ. Predictors of valproate response in bipolar rapid cycling. J Clin Psychopharmacol 1993; 13:280-283.
• Davies LL, Bartolucci A, Petty F. Divalproex in the treatment of bipolar depression: A placebo controlled study. J Affect Disord 2005; 85:259-266.
• Ghaemi SN, Gilmer WS, Goldberg JF, Zablotsky B, Kemp DE, Kelley ME et al. Divalproex in the treatment of acute bipolar depression: A preliminary double-blind, randomized placebo controlled pilot study. J Clin Psychiatry 2007; 68:1840-1844.
• Bowden CL, Calabrase JR, McElroy SL, Gyulai L, Waasef A, Petty F et al. A randomized, placebo-contolled 12- month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintanence Study Group. Arch Gen Psychiatry 2000; 57:481-489.
• Macritchie KA, Geddes JR, Scott J, Haslam DR, Goodwin GM. Valproic acid, valproate and divalproex in the maintenance treatment of bipolar disorder. Cochrane Database Syst Rev 2001; 3:CD003196.
• Lambert PA, Venaud G: Comparative study of valpromide versus lithium as prophylactic treatment in affective disorders. Nervure 1992; 5:57-65.
• Calabrase JR, Shelton MD, Rapport DJ, Youngstorm EA, Jackson K, Bilali S et al. A 20- month, double-blind, maintenance trial of lithium versus divalproex in rapid-cycling bipolar disorder. Am J Psychiatry 2005; 162:2152-2161.
• Calabrase JR, Delucchi GA. Spectrum of efficacy of valproate in 55 patients with rapid-cycling bipolar disorder. Am J Psychiatry 1990; 147:431-443.
• Findling RL, McNamara NK, Youngstrom EA, Stansbery R, Gracious BL, Reed MD et al. Double-blind 18-month trial of lithium versus divalproex maintenance treatment in pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2005; 44:409-417.
• Muller-Oerlinghausen B, Retzow A, Henn FA, Giedke H, Walden J. Valproate as an adjunct to neuroleptic medication for the treatment of acute episodes of mania: a prospective, randomized double-blind, placebo-controlled, multicenter study. European Valproate Mania Study Group. J Clin Psychopharmacol 2000; 20:195-203.
• Gyulai L, Bowden CL, McElroy SL, Calabrase JR, Petty F, Swann AC et al. Maintenance efficacy of divalproex in the prevention of bipolar depression. Neuropsychopharmacology 2003; 28:1374-1382.
• Ballenger JC, Post RM. Carbamazepine in manic depressive illness: A new treatment. Am J Psychiatry 1980; 137:782-790.
• Denicoff KD, Smith-Jackson EE, Disney ER, Ali SO, Leverich GS, Post RM. Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in bipolar disorder. J Clin Psychiatry 1997; 58:470–478.
• Okuma T, Inanaga K, Otsuki S, Sarai K, Takahashi R, Hazama H et al. A preliminary double blind study on the efficacy of carbamazepine in prophylaxis of manic- depressive illness. Psychopharmacology 1981; 73:95-96.
• Greil W, Ludwig-Mayerhofer W, Erazo N, Schochlin C, Schmidt S, Engel RR et al. Lithium versus carbamazepine in the maintenance treatment of bipolar disorders-a randomised study. J Affect Disord 1997; 43:151-161.
• Kleindienst N, Greil W. Differential efficacy of lithium and carbamazepine in the prophylaxis of bipolar disorder. Results of the MAP study. Neuropsychobiology 2000; 42(suppl 1): 2-10.
• Hartong EG, Moleman P, Hoogduin CA, Broekman TG, Nolen W. A Prophylactic efficacy of lithium versus carbamazepine in treatment-naive bipolar patients. J Clin Psychiatry 2003; 64:144-151.
• Greil W, Kleindienst N, Erazo N, Muller-Oerlinghausen B. Differential response to lithium and carbamazepine in the prophylaxis of bipolar disorder. J Clin Psychopharmacol 1998; 18:455-460.
• Stromgren LS. The combination of lithium and carbamazepine in treatment and prevention of manic-depressive disorder: A review and a case report. Compr Psychiatry 1990; 31:261–265.
• Calabrase JR, Rapport DJ, Kimmel SE, Shelton MD. Controlled trials in bipolar I depression: Focus on switch rates and efficacy. Eur Neuropsychopharmacol 1999; 9(suppl 4):109-112.
• Berk M, Segal J, Janet L, Vorster M. Emerging options in the treatment of bipolar disorders. Drugs 2001; 61:1407-1414.
• Bowden CL, Calabrase JR, Sachs G, Yatham LN, Asghar SA, Hompland M et al. A placebo-controlled 18-month trial lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry 2003; 60:392-400.
• Calabrase JR, Bowden CL, Sachs G, Yatham LN, Behnke K, Mehtonen OP et al. A placebo-controlled 18-month trial lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. J Clin Psychiatry 2003; 64:1013- 1024.
• Calabrase JR, Goldberg JF, Ketter TA, Suppes T, Frye M, White R et al. Recurrence in bipolar I disorder: A post hoc analysis excluding relapses in two double-blind maintenance studies. Biol Psychiatry 2006; 59:1061-1064.
• Calabrase JR, Suppes T, Bowden CL, Sachs G, Swann AC, McElroy SL et al. A double- blind, placebo-controlled, prophylaxis study of lamotrigine in rapid-cycling bipolar disorder. Lamictal 614 Study Group. J Clin Psychiatry 2000; 61:841-850.
• Calabrase JR, Vieta E, Shelton MD. Latest maintenance data on lamotrigine in bipolar disorder. Eur Neuropsychopharmacol 2003; 13(suppl 2):s57-s66.
• Goodwin GM, Bowden CL, Calabrase JR, Grunze H, Kasper S, White R et al. A pooled analysis of 2 placebo-controlled 18-months trials lamotrigine and lithium maintenance in bipolar I disorder. J Clin Psychiatry 2004; 65:432-441.
• Bowden CL, Asnis GM, Ginsberg LD, Behtley B, Leadbetter R, White R. Safety and tolerability of lamotrigine for bipolar disorder. Drug Saf 2004; 3:173-184.
• McElroy SL, Keck PE. Clinical pharmacodynamics and pharmacokinetics of antimanic and mood-stabilizing medications. J Clin Psychiatry 2002; 63(suppl 4):3-11.
• Tohen M, Jacobs TG, Grundy SL, McElroy SL, Banov MC, Janicak PG et al. Efficacy of olanzapine in acute bipolar mania: A double-blind, placebo-controlled study. The Olanzapine HGGW Study Group. Arch Gen Psychiatry 2000; 57:841-849.
• Tohen M, Calabrase JR, Sachs GS, Banov MD, Dekte HC, Risser R et al. Randomized, placebo-controlled trial of olanzapine as maintenance therapy in patients with bipolar I disorder responding to acute treatment with olanzapine. Am J Psychiatry 2006; 163:247-256.
• Tohen M, Greil W, Calabrase JR, Sachs GS, Yatham LN, Oerlinghausen BM et al. Olanzapine versus lithium in the maintenance treatment of bipolar disorder:a 12 month randomized, double blind controlled clinical trial. Am J Psychiatry 2005; 162:1281-1290.
• Ketter TA, Houston JP, Adams DH, Risser RC, Meyers AL, Williamson DJ et al. Differential efficacy of olanzapine and lithium in preventing manic or mixed recurrence in patients with bipolar I disorder based on number of previous manic or mixed episodes. J Clin Psychiatry 2006; 67:95-101.
• Tohen M, Ketter TA, Zarate CA, Suppes T, Frye M, Altshuler L et al. Olanzapine versus divalproex sodium for the treatment of acute mania and maintenance of remission: A 47 week study. Am J Psychiatry 2003; 160:1263-1271.
• Tohen M, Chengappa KN, Suppes T, Zarate CA, Calabrase JR, Bowden CL et al. Efficacy of olanzapine in combination with valproate or lithium in the treatment of mania in patients partially nonresponsive to valproate or lithium monotherapy. Arch Gen Psychiatry 2002; 59:62-69.
• Tohen M, Chengappa KN, Suppes T, Baker RW, Zarate CA, Bowden CL et al. Relapse prevention in bipolar I disorder:18 month comparison of olanzapine plus mood stabiliser v. mood stabiliser alone. Br J Psychiatry 2004; 184:337-345.
• Houston JP, Ahl J, Meyers AL, Kaiser CJ, Tohen M, Baldessarini RJ. Reduced suicidal ideation in bipolar I disorder mixed-episode patients in a placebo controlled trial of olanzapine combined with lithium or divalproex. J Clin Psychiatry 2006; 67:1246- 1252.
• Colom F, Vieta E, Daban C, Pacchiarotti I, Sanchez-Moreno J. Clinical and therapeutic implications of predominant polarity in bipolar disorder. J Affect Disord 2006; 93:13- 17.
• Rosa AR, Andreazza AC, Kunz M, Gomes F, Santin A, Sanchez-Moreno et al. Predominant polarity in bipolar disorder: Diagnostic implications. J Affect Disord 2008; 107:45-51.
• Keck Jr. PE, Marcus R, Tourkodimitris S, Ali M, Liebeskind A, Saha A et al. A placebo- controlled double-blind study of the efficacy and safety of aripiprazole in patients with acute bipolar mania. Am J Psychiatry 2003; 160:1651-1658.
• Keck PE Jr, Orsulak P, Cutler A, Sanchez R, Torbeyns A, Marcus R et al. Aripiprazole monotherapy in the treatment of acute bipolar I mania: a randomized placebo and lithium controlled study. J Affect Disord 2009; 112:36-49.
• Suppes T, Eudicone J, McQuade R, Pikalov A 3rd, Carlson B. Efficacy and safety of aripiprazole in subpopulations with acute manic or mixed episodes of bipolar I disorder. J Affect Disord 2008; 107:145-154
• Keck PE Jr, Calabrase JR, McIntyre RS, McQuade RD, Carson WH, Eudicone JM et al. Aripiprazole monotherapy for maintenance therapy in bipolar I disorder:a 100-week, double-blind study versus placebo. J Clin Psychiatry 2007; 68:1480-1491.
• Keck Jr. PE, Calabrase JR, McQuade RD, Carson WH, Carlson BX, Rollin LM et al. A randomized double blind placebo controlled 26 week trial of aripiprazole in recently manic patients with bipolar I disorder. J Clin Psychiatry 2006; 67:626-637.
• Bowden CL, Grunze H, Mullen J, Brecher M, Paulsson B, Jones M et al. A randomized double blind placebo controlled efficacy and safety study of quetiapine or lithium as monotherapy for mania in bipolar disorder. J Clin Psychiatry 2005; 66:111-121.
• Suppes T, Liu S, Brecher M, Paulsson B, Lazarus A. Maintenance treatment in bipolar I disorder with quetiapine concomitant with lithium or divalproex:a placebo controlled randomized multicenter trial (trial 1447C00127). Bipolar Disord 2008; 10(suppl 1):1- 29.
• Vieta E, Suppes T, Eggens I, Persson I, Paulsson B, Brecher M. Efficacy and safety of quetiapine in combination with lithium or divalproex for maintenance of patients with bipolar I disorder (international trial 126). J Affect Disord 2008; 109:251-263.
• Fountoulakis KN, Vieta E. Treatment of bipolar disorder: A systematic review of available data and clinical perspectives. Int J Neuropsychopharmacol 2008; 11:999