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Cited by 76Bipolar Disorder and TreatmentTreatment of Major DepressionPersonality Disorders and Psychopathology

Treatment of bipolar disorder: a complex treatment for a multi-faceted disorder

Open access
Fountoulakis, Konstantinos N, Vieta, Eduard, Siamouli, Melina, Valenti, Marc, Magiria, Stamatia, Oral, Timucin, Fresno, David, Giannakopoulos, Panteleimon +1 more·2007·Annals of General Psychiatry
DOI 10.1186/1744-859x-6-27PMC PMC2089060
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Abstract

BACKGROUND: Manic-depression or bipolar disorder (BD) is a multi-faceted illness with an inevitably complex treatment. METHODS: This article summarizes the current status of our knowledge and practice of its treatment. RESULTS: It is widely accepted that lithium is moderately useful during all phases of bipolar illness and it might possess a specific effectiveness on suicidal prevention. Both first and second generation antipsychotics are widely used and the FDA has approved olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole for the treatment of acute mania. These could also be useful in the treatment of bipolar depression, but only limited data exists so far to support the use of quetiapine monotherapy or the olanzapine-fluoxetine combination. Some, but not all, anticonvulsants possess a broad spectrum of effectiveness, including mixed dysphoric and rapid-cycling forms. Lamotrigine may be effective in the treatment of depression but not mania. Antidepressant use is controversial. Guidelines suggest their cautious use in combination with an antimanic agent, because they are supposed to induce switching to mania or hypomania, mixed episodes and rapid cycling. CONCLUSION: The first-line psychosocial intervention in BD is psychoeducation, followed by cognitive-behavioral therapy. Other treatment options include Electroconvulsive therapy and transcranial magnetic stimulation. There is a gap between the evidence base, which comes mostly from monotherapy trials, and clinical practice, where complex treatment regimens are the rule.

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  • Currently, atypical antipsychotics are only considered by treatment guidelines as second- or third-line therapy in the management of bipolar depression.

    “Currently, atypical antipsychotics are only considered by treatment guidelines as second-or third-line therapy in the management of bipolar depression”

    From Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: a meta-analysis (2010) · cites this paper as Fountoulakis et al. 2007

    Table 1 in the Background section lists olanzapine, an atypical antipsychotic, as a first-step treatment for acute bipolar depression under the 2002 TMAP guideline. That contradicts the claim that guidelines consider atypical antipsychotics only as second- or third-line therapy. (LLM, conf=0.88)

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Research works printed but not linked: 2

  1. Goldberg JF Treatment guidelines: current and future management of bipolar disorder J Clin Psychiatry 2000 61 Supp 13 12 18 11153806
  2. Endicott J Rajagopalan K Minkwitz M Macfadden W A randomized, double-blind, placebo-controlled study of quetiapine in the treatment of bipolar I and II depression: improvements in quality of life Int Clin Psychopharmacol 2007 22 29 37 17159457

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Authors
Fountoulakis, K. N., Vieta, E., Siamouli, M., Valenti, M., Magiria, S., Oral, T., Fresno, D., Giannakopoulos, P., & Kaprinis, G. S.
Affiliations
  • Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES)
  • Aristotle University of Thessaloniki (GR)
ORCID
Vieta, Eduard
Venue
Annals of General Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2007-10-09
Volume
6
Issue
1
Pages
27-27
ISSN
1744-859X (ISSN-L)
DOI
10.1186/1744-859x-6-27
PMC
PMC2089060
OpenAlex
W2148843343
Cited by
76
References
181
Citations by year
2026: 1 · 2025: 4 · 2024: 1 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 4 · 2017: 3 · 2016: 3 · 2015: 2 · 2014: 5 · 2013: 6 · 2012: 7
FWCI
5.25
Type
journal article
Language
en
Open access
Licence
Locations
  • Annals of General Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RECERCAT (Consorci de Serveis Universitaris de Catalunya) (publishedVersion, other-oa)
  • Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Eli Lilly and Company
  • Pfizer
  • Sanofi
  • Servier
  • H. Lundbeck A/S
  • Pfizer Foundation
  • Cilag
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
bipolar disorder, bipolar disorder treatment, lithium, antipsychotic drugs, olanzapine, risperidone, quetiapine, ziprasidone, aripiprazole, bipolar depression, antiepileptic drugs, lamotrigine, antidepressants, mixed states, rapid cycling, suicide prevention, psychoeducation, cognitive behavioral therapy, electroconvulsive therapy, transcranial magnetic stimulation

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