Priority 8 from the Bipolar PSP
| UNCERTAINTY: Which are the best medications for treating episodes and for prevention of relapse in bipolar? (JLA PSP Priority 8) | |
|---|---|
| Overall ranking | 8 |
| JLA question ID | 0041/8 |
| Explanatory note | Not available for this PSP |
| Evidence |
Depression: Tamayo JM, Zarate CA Jr, Vieta E, Vazquez G, Tohen M. Level of response and safety of pharmacological monotherapy in the treatment of acute bipolar I disorder phases: a systematic review and meta-analysis. Int J Neuropsychopharmacol 2010; 13: 813–832. [Comment: 6 years old] Fountoulakis KN, Vieta E, Schmidt F. Aripiprazole monotherapy in the treatment of bipolar disorder: a meta analysis. J Affect Disord 2011; 133: 361–370. [Comment: Single drug focus; 5 years old] Fountoulakis KN, Gonda X, Vieta E, Schmidt F. Treatment of psychotic symptoms in bipolar disorder with aripiprazole monotherapy: a meta-analysis. Ann Gen Psychiatry 2009; 8: 27. [Comment: Single drug focus; 7 years old] Bond DJ, Lam RW, Yatham LN. Divalproex sodium versus placebo in the treatment of acute bipolar depression: a systematic review and meta-analysis. J Affect Disord 2010; 124: 228–234. [Comment: Single drug focus; 6 years old] Smith LA, Cornelius VR, AzorinJMet al. Valproate for the treatment of acute bipolar depression: systematic review and meta-analysis. J Affect Disord 2010; 122: 1–9. [Comment: Single drug focus; 6 years old] Smith LA, Cornelius V, Warnock A, Tacchi MJ, Taylor D. Pharmacological interventions for acute bipolar mania: a systematic review of randomized placebo-controlled trials. Bipolar Disord 2007; 9: 551–560. [Comment: 9 years old] Scherk H, Pajonk FG, Leucht S. Second-generation antipsychotic agents in the treatment of acute mania: a systematic review and meta-analysis of randomized controlled trials. Arch Gen Psychiatry 2007; 64: 442–455. [Comment: 9 years old] 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: Single drug focus; 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: Single drug focus; 10 years old] Consoli A, Bouzamondo A, Guile JM, Lechat P, Cohen D. Comorbidity with ADHD decreases response to pharmacotherapy in children and adolescents with acute mania: evidence from a meta analysis. Can J Psychiatry 2007; 52: 323–328. [Comment: 9 years old] Relapse prevention: Smith LA, Cornelius V, Warnock A, Bell A, Young AH. Effectiveness of mood stabilizers and antipsychotics in the maintenance phase of bipolar disorder: a systematic review of randomized controlled trials. Bipolar Disord 2007; 9: 394–412. [Comment: 9 years old] |
| Health Research Classification System category | Mental Health |
| Extra information provided by this PSP | |
|---|---|
| Original uncertainty examples | For full examples, see Category ID T8 on spreadsheet. Is olanzapine as good as lithium for bipolar with mostly depressive symptoms? ~ Which antipsychotic is best as a mood stabiliser Could drugs be repurposed as mood stabilisers? ~ Just how reliable is evidence for the effectiveness of drug treatment? some of the claimed effects seem to be at best marginal. ~ Is Lamotragine better than Lithium? ~ Effectiveness of Aripiprazole in bipolar depression ~ How effective are medications such as quietipine (mine seems to work extremely well. ~ In cases where a bipolar person experiences an increase in frequency of manic episodes, what is the best treatment? ~ Why does medication manage the mania but not the lows? Mood stabilisers, anti psychotics and even anti depressants don't help. ~ Is it possible to find a drug treatment that will keep me well, without manic or depressive episodes? |
| Submitted by | Patients x 91 ~ Carers x 50 ~ Health Professionals x 26 ~ Others x 11 |
| 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 |