From the Guidelines
Bipolar disorder should be treated with a combination of traditional mood stabilizers, such as lithium or valproate, and/or atypical antipsychotic medications, as these are the primary treatments for acute mania, as noted in the practice parameter for the assessment and treatment of children and adolescents with bipolar disorder 1. The treatment of bipolar disorder is complex and typically involves a combination of medication and psychotherapy.
- The primary medications used are mood stabilizers like lithium and valproate, often combined with atypical antipsychotics such as quetiapine, olanzapine, or aripiprazole.
- For bipolar depression, medications like lurasidone or cariprazine may be prescribed, although it is essential to note that no single agent is approved by the FDA for the treatment of all phases of bipolar disorder 1. The disorder has a strong genetic component and involves dysregulation of neurotransmitters and neural circuits that control mood.
- Early diagnosis and consistent treatment significantly improve outcomes and quality of life for those with bipolar disorder.
- Regular sleep patterns, stress management, and avoiding alcohol and recreational drugs are crucial for stability. It is also important to consider that most agents only have clearly demonstrated efficacy for treating acute manic symptoms in adults 1, thus the term antimanic may be a more accurate description.
- Psychotherapy approaches include cognitive behavioral therapy, interpersonal therapy, and family-focused therapy, which can be used as adjunctive therapy or to address comorbid conditions and problems.
From the Research
Definition and Prevalence of Bipolar Disorder
- Bipolar disorder affects approximately 8 million adults in the US and approximately 40 million individuals worldwide 2
- It is characterized by recurrent episodes of depression and mania or hypomania 2
Symptoms and Diagnosis
- Bipolar depressive episodes are similar to major depressive episodes 2
- Manic and hypomanic episodes are characterized by a distinct change in mood and behavior during discrete time periods 2
- The age of onset is usually between 15 and 25 years, and depression is the most frequent initial presentation 2
- Approximately 75% of symptomatic time consists of depressive episodes or symptoms 2
Treatment and Management
- Early diagnosis and treatment are associated with a more favorable prognosis 2
- Long-term treatment consists of mood stabilizers, such as lithium, valproate, and lamotrigine 2
- Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are recommended, but some are associated with weight gain 2
- Antidepressants are not recommended as monotherapy 2, 3, 4
- Lithium is an effective mood stabilizer that is used principally for the management of bipolar disorder (BD) 5, 6
- Olanzapine + fluoxetine should be first-line treatment for bipolar depression 3
Complications and Prognosis
- Life expectancy is reduced by approximately 12 to 14 years in people with bipolar disorder, with a 1.6-fold to 2-fold increase in cardiovascular mortality occurring a mean of 17 years earlier compared with the general population 2
- Prevalence rates of metabolic syndrome (37%), obesity (21%), cigarette smoking (45%), and type 2 diabetes (14%) are higher among people with bipolar disorder, contributing to the risk of early mortality 2
- The annual suicide rate is approximately 0.9% among individuals with bipolar disorder, compared with 0.014% in the general population 2
- Approximately 15% to 20% of people with bipolar disorder die by suicide 2