From the Guidelines
Bipolar disorder is best managed with a comprehensive approach that includes pharmacotherapy, psychological interventions, and community support, prioritizing mood stabilizers like lithium and anticonvulsants, alongside psychosocial treatments such as family-focused therapy and cognitive behavioral therapy, as supported by recent studies 1.
Clinical Manifestations
Bipolar disorder is characterized by three key clinical manifestations:
- Mood swings between depression and mania/hypomania
- Changes in energy and activity levels
- Impaired functioning in daily life During manic episodes, patients may experience elevated mood, decreased need for sleep, and grandiose thinking, while depressive episodes involve persistent sadness, loss of interest, and suicidal thoughts. Mixed episodes can also occur, with features of both mania and depression simultaneously.
Clinical Management in New Zealand
Management in New Zealand typically includes three main approaches:
- Pharmacotherapy: with mood stabilizers such as lithium (typically starting at 400mg twice daily, aiming for serum levels of 0.6-0.8 mmol/L) 1, anticonvulsants like sodium valproate (starting at 500mg daily, increasing to 1000-2000mg daily), or atypical antipsychotics such as olanzapine (5-20mg daily)
- Psychological interventions: including cognitive behavioral therapy and psychoeducation, which are essential for symptom management and relapse prevention, as supported by recent studies 1
- Community support: through specialized mental health services, with regular monitoring by mental health professionals and crisis intervention when needed This comprehensive approach addresses both the biological basis of mood dysregulation and the psychosocial factors that influence the course of bipolar disorder, aiming for symptom control and improved quality of life.
From the FDA Drug Label
As oral formulation for the: Acute treatment of manic or mixed episodes associated with bipolar I disorder and maintenance treatment of bipolar I disorder. Adults: Efficacy was established in three clinical trials in patients with manic or mixed episodes of bipolar I disorder: two 3- to 4-week trials and one maintenance trial. Adolescents (ages 13-17): Efficacy was established in one 3-week trial in patients with manic or mixed episodes associated with bipolar I disorder
The clinical manifestations of bipolar disorder include:
- Manic episodes
- Mixed episodes
- Depressive episodes
The clinical management of bipolar disorder includes:
- Medications: such as olanzapine, which is indicated for the acute treatment of manic or mixed episodes associated with bipolar I disorder and maintenance treatment of bipolar I disorder.
- Dosage: The recommended starting dose for olanzapine is 10 or 15 mg once daily for adults, and 2.5-5 mg once daily for adolescents.
- Combination therapy: Olanzapine may be used in combination with other medications, such as lithium or valproate, for the treatment of manic or mixed episodes associated with bipolar I disorder. 2
From the Research
Clinical Manifestation of Bipolar Disorder
- Bipolar disorder is characterized by recurrent episodes of depression and mania or hypomania 3
- Bipolar depressive episodes are similar to major depressive episodes, while manic and hypomanic episodes are characterized by a distinct change in mood and behavior during discrete time periods 3
- The age of onset is usually between 15 and 25 years, and depression is the most frequent initial presentation 3
Clinical Management of Bipolar Disorder in NZ
- First-line therapy includes mood stabilizers, such as lithium, anticonvulsants, such as valproate and lamotrigine, and atypical antipsychotic drugs, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine 3, 4
- Lithium may be effective in treating acute mania, and lithium efficacy is maximized when used to prevent both manic and depressive episodes 5
- Valproate may be more effective as an antimanic rather than prophylactic agent, and may be a better choice in patients with many previous affective episodes/hospitalizations and psychiatric comorbidities 5
- Long-term treatment consists of mood stabilizers, and antipsychotic agents are recommended, but some are associated with weight gain 3