Priority 17 from the Bipolar PSP

UNCERTAINTY:How effective are combinations of medication, e.g. antidepressant plus a mood-stabilising drug, in the treatment of bipolar? (JLA PSP Priority 17)
Overall ranking	17
JLA question ID	0041/17
Explanatory note	Not available for this PSP.
Evidence	Rendell JM, Gijsman HJ, Bauer MS, Goodwin GM, Geddes GR. Risperidone alone or in combination for acute mania. Cochrane Database Syst Rev 2006; CD004043. [Comment: 10 years old] Smith LA, Cornelius V, Warnock A, Tacchi MJ, Taylor D. Acute bipolar mania: a systematic review and meta-analysis of co-therapy vs. monotherapy. Acta Psychiatr Scand 2007; 115: 12–20. [Comment: 9 years old] Cipriani A, Rendell JM, Geddes JR. Haloperidol alone or in combination for acute mania. Cochrane Database Syst Rev 2006; 3: CD004362. [Comment: 10 years old] Cruz N, Sanchez-Moreno J, Torres F, Goikolea JM, Valenti M, Vieta E. Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: a meta-analysis. Int J Neuropsychopharmacol 2010; 13: 5–14. [Comment: 6 years old] Vieta E, Locklear J, Gunther O et al. Treatment options for bipolar depression: a systematic review of randomized, controlled trials. J Clin Psychopharmacol 2010; 30: 579–590. [Comment: 6 years old]
Health Research Classification System category	Mental Health

Extra information provided by this PSP
Original uncertainty examples	For full examples, see Category ID T9 on spreadsheet. How do various drug treatments act in combination? ~ Is there a proven combination to stop auditory hallucinations, boost mood and stabilse moods. Eg anti psychotics, anti depressants and mood stabilisers ~ Is a combination of drugs taken at lower doses more helpful than larger doses of a single drug? ~ Is it essential to be off anti-depressants completely, or can they be taken in conjunction with mood stabilisers? ~ Can manic and mixed episodes be treat with a "reliever" medication that is taken when needed on top of regular medication?
Submitted by	Patients x 23 ~ Carers x 7 ~ Health Professionals x 4

Extra information provided by this PSP

Original uncertainty examples

For full examples, see Category ID T9 on spreadsheet. How do various drug treatments act in combination? ~ Is there a proven combination to stop auditory hallucinations, boost mood and stabilse moods. Eg anti psychotics, anti depressants and mood stabilisers ~ Is a combination of drugs taken at lower doses more helpful than larger doses of a single drug? ~ Is it essential to be off anti-depressants completely, or can they be taken in conjunction with mood stabilisers? ~ Can manic and mixed episodes be treat with a "reliever" medication that is taken when needed on top of regular medication?

Submitted by

Patients x 23 ~ Carers x 7 ~ Health Professionals x 4

PSP information
PSP unique ID	0041
PSP name	Bipolar
Total number of uncertainties identified by this PSP.	363 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	14 June 2016