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Cited by 848Bipolar Disorder and TreatmentTreatment of Major DepressionSchizophrenia research and treatment

Treatment of bipolar disorder

Open access
Geddes, John R, Miklowitz, David J·2013·The Lancet
DOI 10.1016/s0140-6736(13)60857-0PMC PMC3876031
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Abstract

We review recent developments in the acute and long-term treatment of bipolar disorder and identify promising future routes to therapeutic innovation. Overall, advances in drug treatment remain quite modest. Antipsychotic drugs are effective in the acute treatment of mania; their efficacy in the treatment of depression is variable with the clearest evidence for quetiapine. Despite their widespread use, considerable uncertainty and controversy remains about the use of antidepressant drugs in the management of depressive episodes. Lithium has the strongest evidence for long-term relapse prevention; the evidence for anticonvulsants such as divalproex and lamotrigine is less robust and there is much uncertainty about the longer term benefits of antipsychotics. Substantial progress has been made in the development and assessment of adjunctive psychosocial interventions. Long-term maintenance and possibly acute stabilisation of depression can be enhanced by the combination of psychosocial treatments with drugs. The development of future treatments should consider both the neurobiological and psychosocial mechanisms underlying the disorder. We should continue to repurpose treatments and to recognise the role of serendipity. We should also investigate optimum combinations of pharmacological and psychotherapeutic treatments at different stages of the illness. Clarification of the mechanisms by which different treatments affect sleep and circadian rhythms and their relation with daily mood fluctuations is likely to help with the treatment selection for individual patients. To be economically viable, existing psychotherapy protocols need to be made briefer and more efficient for improved scalability and sustainability in widespread implementation.

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Crossref · 10.1016/s0140-6736(13)60857-0

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  • Existing psychological interventions such as CBT, family-focused therapy and psychoeducation have common components including preventing relapse, stabilising mood and increasing functioning.

    “Existing psychological interventions such as cognitive behavioural therapy (CBT), family-focused therapy and psychoeducation have common components including preventing relapse, stabilising mood and increasing functioning (Da Costa et al., 2011; Geddes & Miklowitz, 2013).”

    From What are People's Experiences of a Novel Cognitive Behavioural Therapy for Bipolar Disorders? A Qualitative Investigation with Participants on the TEAMS Trial. (2017) · cites this paper as Geddes & Miklowitz, 2013

    The Psychosocial treatments section (page unavailable) identifies CBT, family-focused therapy, and group psychoeducation as models with common objectives, including recognising early signs of recurrence and maintaining regular habits. The long-term maintenance section discusses relapse reduction and social functioning, but does not establish increased functioning as a common component or objective of all three interventions. (LLM, conf=0.82)

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  • Existing interventions tend not to target current subclinical symptoms and comorbid diagnoses, in favour of focusing on future-oriented outcomes such as relapse prevention and improving long-term social and occupational functioning.

    “However, existing interventions tend not to target current subclinical symptoms and comorbid diagnoses, in favour of focusing on future-oriented outcomes such as relapse prevention and improving long-term social and occupational functioning (Geddes & Miklowitz, 2013).”

    From What are People's Experiences of a Novel Cognitive Behavioural Therapy for Bipolar Disorders? A Qualitative Investigation with Participants on the TEAMS Trial. (2017) · cites this paper as Geddes & Miklowitz, 2013

    The 'Adjunctive psychotherapy in long-term maintenance' section (page unavailable) says most psychotherapy studies are maintenance trials and reports outcomes for relapse and social functioning, supporting the claim about future-oriented outcomes. It does not establish that existing interventions generally neglect current subclinical symptoms or comorbid diagnoses; the family-focused therapy subsection also describes alleviation of residual symptoms. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The efficacy of antidepressants for BD requires more evidence.

    “We also found that the efficacy of antidepressants for BD requires more evidence [68–70].”

    From Bright light therapy in the treatment of patients with bipolar disorder: A systematic review and meta-analysis (2020) · cites this paper as [68]

  • Effective treatment of bipolar disorders is considered a significant challenge.

    “Effective treatment of bipolar disorders is considered a significant challenge (Geddes & Miklowitz, 2013).”

    From What are People's Experiences of a Novel Cognitive Behavioural Therapy for Bipolar Disorders? A Qualitative Investigation with Participants on the TEAMS Trial. (2017) · cites this paper as Geddes & Miklowitz, 2013

  • These features are particularly important in patients with a short course of disease who have no overt symptoms or only observed depressive symptoms.

    “These features are particularly important in patients with a short course of disease who have no overt symptoms or only observed depressive symptoms (as most BD patients exhibit depressive symptoms during their early episodes)10,59,60.”

    From Optimizing multi-domain hematologic biomarkers and clinical features for the differential diagnosis of unipolar depression and bipolar depression (2023) · cites this paper as [60]

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Research works printed but not linked: 1

  1. [90]Beck AT Rush AJ Shaw BF Emery G Cognitive therapy of depression 1987 Guilford Press New York

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Authors
Geddes, J. R., & Miklowitz, D. J.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Geddes, John R
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2013-05
Volume
381
Issue
9878
Pages
1672-1682
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(13)60857-0
PMC
PMC3876031
OpenAlex
W2167193785
Cited by
848
References
119
Citations by year
2026: 44 · 2025: 78 · 2024: 44 · 2023: 43 · 2022: 58 · 2021: 77 · 2020: 62 · 2019: 53 · 2018: 66 · 2017: 74 · 2016: 72 · 2015: 72 · 2014: 85 · 2013: 14 · 2012: 2
FWCI
11.05
Type
journal article
Language
en
Open access
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute for Health and Care Research (NF-SI-0611-10150)
  • National Institute of Mental Health (R01MH093676, R21MH097007)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
bipolar disorder, mania, bipolar depression, antipsychotic drugs, quetiapine, antidepressants, lithium, relapse prevention, divalproex, lamotrigine, antiepileptic drugs, psychosocial interventions, adjunctive psychotherapy, pharmacotherapy
MeSH terms
Anticonvulsants, Antidepressive Agents, Bipolar Disorder, Electroconvulsive Therapy, Humans, Lithium, Psychotherapy, Antipsychotic Agents, Practice Guidelines as Topic, Antimanic Agents

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