Advertisement

The Role of Polypharmacy in Bipolar Disorder Treatment Guidelines

  • Heinz Grunze
Chapter

Abstract

Polypharmacy is rather the rule than the exception in the real world treatment of bipolar disorder. Guidelines do support combination treatments, but with a solitary focus of efficacy. This leads to an apparent discrepancy between the recommendations of combination treatment in guidelines and the treatment plan in clinical patient samples where factors influencing choices are more complex and not resembled by randomised controlled studies (RCTs). This article highlights the treatment recommendations of three major, up- to date guidelines and the positioning of combination treatments in acute mania, bipolar depression and maintenance treatment.

Keywords

Bipolar Disorder Combination Treatment Bipolar Patient Bipolar Depression Acute Mania 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

AAP

Atypical antipsychotic

AD

Antidepressant

AM

Antimanic agent

AMSP

Arzneimittelsicherheit in der Psychiatrie (Surveillance study of drug safety in Psychiatry)

BAP

British Association of Psychopharmacology

BD

Bipolar Disorder

CANMAT

Canadian Network for Mood and Anxiety Treatments

ISBD

International Society for Bipolar Disorders

Li

Lithium

RCT

Randomised Controlled Studies

STEP-BD

Systematic Treatment Enhancement Program for Bipolar Disorder

TEAE

Treatment emergent affective episodes

VPA

Valproate

WFSBP

World Federation of Societies of Biological Psychiatry

References

  1. 1.
    Frye MA, Ketter TA, Leverich GS et al (2000) The increasing use of polypharmacotherapy for refractory mood disorders: 22 years of study. J Clin Psychiatry 61:9–15PubMedCrossRefGoogle Scholar
  2. 2.
    Mojtabai R, Olfson M (2010) National trends in psychotropic medication polypharmacy in office-based psychiatry. Arch Gen Psychiatry 67:26–36PubMedCrossRefGoogle Scholar
  3. 3.
    Wolfsperger M, Greil W, Rossler W, Grohmann R (2007) Pharmacological treatment of acute mania in psychiatric in-patients between 1994 and 2004. J Affect Disord 99:9–17PubMedCrossRefGoogle Scholar
  4. 4.
    Haeberle A, Greil W, Russmann S, Grohmann R (in press) Mono- and combination drug therapies in hospitalized patients with bipolardepression. Data from the European drug surveillance program AMSP. BMC PsychiatryGoogle Scholar
  5. 5.
    Walpoth-Niederwanger M, Kemmler G, Grunze H, Weiss U, Hoertnagl C, Strauss R et al (in press) Treatment patterns in inpatients with bipolar disorder at a psychiatric university hospital over a 9-year period: focus on mood stabilizers. Int Clin PsychopharmacolGoogle Scholar
  6. 6.
    Poulsen RL (1992) Some current factors influencing the prescribing and use of psychiatric drugs. Public Health Rep 107:47–53PubMedGoogle Scholar
  7. 7.
    Post RM, Altshuler LL, Frye MA, Suppes T, Keck PE Jr, McElroy SL et al (2010) Complexity of pharmacologic treatment required for sustained improvement in outpatients with bipolar disorder. J Clin Psychiatry 71:1176–1186PubMedCrossRefGoogle Scholar
  8. 8.
    Goldberg JF, Brooks JO III, Kurita K et al (2009) Depressive illness burden associated with complex polypharmacy in patients with bipolar disorder: findings from the STEP-BD. J Clin Psychiatry 70:155–162PubMedCrossRefGoogle Scholar
  9. 9.
    Dennehy EB, Suppes T, Rush AJ et al (2005) Does provider adherence to a treatment guideline change clinical outcomes for patients with bipolar disorder? Results from the Texas medication algorithm project. Psychol Med 35:1695–1706PubMedCrossRefGoogle Scholar
  10. 10.
    Perlis RH (2007) Use of treatment guidelines in clinical decision making in bipolar disorder: a pilot survey of clinicians. Curr Med Res Opin 23:467–475PubMedCrossRefGoogle Scholar
  11. 11.
    Samalin L, Guillaume S, Auclair C, Llorca PM (2011) Adherence to guidelines by French psychiatrists in their real world of clinical practice. J Nerv Ment Dis 199:239–243PubMedCrossRefGoogle Scholar
  12. 12.
    Turner EH, Matthews AM, Linardatos E et al (2008) Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 358:252–260PubMedCrossRefGoogle Scholar
  13. 13.
    Ghaemi NS, Shirzadi AA, Filkowski M (2008) Publication bias and the pharmaceutical industry: the case of lamotrigine in bipolar disorder. Medscape J Med 10:211Google Scholar
  14. 14.
    Heres S, Davis J, Maino K, Jetzinger E, Kissling W, Leucht S (2006) Why olanzapine beats risperidone, risperidone beats quetiapine, and quetiapine beats olanzapine: an exploratory analysis of head-to-head comparison studies of second-generation antipsychotics. Am J Psychiatry 163:185–194PubMedCrossRefGoogle Scholar
  15. 15.
    Cosgrove L, Bursztajn HJ, Krimsky S, Anaya M, Walker J (2009) Conflicts of interest and disclosure in the American Psychiatric Association’s Clinical Practice Guidelines. Psychother Psychosom 78:228–232PubMedCrossRefGoogle Scholar
  16. 16.
    Grunze H, Vieta E, Goodwin GM et al (2009) The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2009 on the treatment of acute mania. World J Biol Psychiatry 10:85–116PubMedCrossRefGoogle Scholar
  17. 17.
    Licht RW (2002) Limits of the applicability and generalizability of drug trials in mania. Bipolar Disord 4(Suppl 1):66–68PubMedCrossRefGoogle Scholar
  18. 18.
    Nivoli AM, Murru A, Goikolea JM et al (2012) New treatment guidelines for acute bipolar mania: a critical review. J Affect Disord 140:125–141PubMedCrossRefGoogle Scholar
  19. 19.
    Vieta E, Panicali F, Goetz I, Reed C, Comes M, Tohen M (2008) Olanzapine monotherapy and olanzapine combination therapy in the treatment of mania: 12-week results from he European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) observational study. J Affect Disord 106:63–72PubMedCrossRefGoogle Scholar
  20. 20.
    Streeruwitz A, Barnes TR, Fehler J, Ohlsen R, Curtis VA (2007) Pharmacological management of acute mania: does current prescribing practice reflect treatment guidelines? J Psychopharmacol 21:206–209PubMedCrossRefGoogle Scholar
  21. 21.
    Grunze H, Vieta E, Goodwin GM et al (2010) The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2010 on the treatment of acute bipolar depression. World J Biol Psychiatry 11:81–109PubMedCrossRefGoogle Scholar
  22. 22.
    Grunze H, Vieta E, Goodwin GM, et al (in press) The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2012 on the Long-term Treatment of Bipolar Disorder. World J Biol PsychiatryGoogle Scholar
  23. 23.
    Yatham LN, Kennedy SH, Schaffer A et al (2009) Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disord 11:225–255PubMedCrossRefGoogle Scholar
  24. 24.
    Goodwin GM (2009) Evidence-based guidelines for treating bipolar disorder: revised ­second edition –recommendations from the British Association for Psychopharmacology. J Psychopharmacol 23:346–388PubMedCrossRefGoogle Scholar
  25. 25.
    Grunze H, Forsthoff A, Born C (2005) Polypharmazie in der behandlung bipolarer störungen. In: Messer T, Schmauss M (eds) Polypharmazie in der behandlung psychischer erkrankungen. Springer, Wien/New York, pp 81–102Google Scholar
  26. 26.
    Ghaemi SN, Hsu DJ, Thase ME et al (2006) Pharmacological treatment patterns at study entry for the first 500 STEP-BD participants. Psychiatr Serv 57:660–665PubMedCrossRefGoogle Scholar
  27. 27.
    Goodwin GM, Anderson I, Arango C et al (2008) ECNP consensus meeting. Bipolar depression. Nice, March 2007. Eur Neuropsychopharmacol 18:535–549PubMedCrossRefGoogle Scholar
  28. 28.
    Kasper S, Calabrese JR, Johnson G, Tajima O, Vieta E, Viguera AC et al (2008) International consensus group on the evidence-based pharmacologic treatment of bipolar I and II depression. J Clin Psychiatry 69:1632–1646CrossRefGoogle Scholar
  29. 29.
    van der Loos ML, Mulder PG, Hartong EG, Blom MB, Vergouwen AC, de Keyzer HJ et al (2009) Efficacy and safety of lamotrigine as add-on treatment to lithium in bipolar depression: a multicenter, double-blind, placebo-controlled trial. J Clin Psychiatry 70:223–231PubMedCrossRefGoogle Scholar
  30. 30.
    Kupfer DJ, Frank E, Grochocinski VJ et al (2000) Stabilization in the treatment of mania, depression and mixed states. Acta Neuropsychiatrica 12:3–114Google Scholar
  31. 31.
    Rybakowski J (2007) Long-term pharmacological treatment of bipolar disorders. Neuro Endocrinol Lett 28(Suppl 1):71–93PubMedGoogle Scholar
  32. 32.
    Goodwin G, Vieta E (2005) Effective maintenance treatment – breaking the cycle of bipolar disorder. Eur Psychiatry 20:365–371PubMedCrossRefGoogle Scholar
  33. 33.
    Goetz I, Tohen M, Reed C, Lorenzo M, Vieta E (2007) Functional impairment in patients with mania: baseline results of the EMBLEM study. Bipolar Disord 9:45–52PubMedCrossRefGoogle Scholar
  34. 34.
    Geddes JR, Goodwin GM, Rendell J et al (2010) Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial. Lancet 375:385–395PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Institute of Neuroscience, Academic Psychiatry, Campus of Aging and Vitality, Wolfson Research CentreNewcastle UniversityNewcastle upon TyneUK

Personalised recommendations