An overview of pharmacotherapy for bipolar I disorder

ABSTRACT

Introduction: Bipolar I disorder (BD I) is complex with a chronic course that significantly impacts a sufferer’s quality of life. As of right now, there are many available treatments that aim to rapidly treat manic or depressive episodes and stabilize mood. The purpose of this report is to provide an up-to-date comprehensive review of the available evidence-based trials of pharmacotherapy for the treatment of BD I.

Areas covered: This paper reviews randomized active comparator-controlled or placebo-controlled trials evaluating the use of current pharmacotherapy in adults with BD I from phase III to clinical practice. Monotherapy and combination therapy for acute and long-term treatment were reviewed for this purpose.

Expert opinion: There are many treatments available for BD mania; however, the depressive and stabilization phases of the illness remain a clinical challenge. Unfortunately, randomized controlled trials do not represent ‘real world’ patients, as their strict inclusion and exclusion criteria do not allow for different features sometimes present in patients to be considered. Research efforts must also focus on treating cognitive deficits, which adds to lower functional outcome. The authors believe that there is dire need for new, more targeted treatments in BD I, with a critical view of the side effects.

KEYWORDS:

• Bipolar disorder
• depression
• mania
• pharmacotherapy
• treatment

Declaration of Interest

M Morrens received financial support for research purposes and scientific presentations from Johnson & Johnson, AstraZeneca, Lundbeck, and Bristol–Myers Squibb. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Article highlights

• Many treatment options are available for BD mania; however depressive episodes remain a challenge

• Maintenance therapy also remains a challenge, with very few studies conducted

• Tolerability of medication need to be considered, as this has a large impact on treatment adherence

• Randomized controlled trials do not represent ‘real world’ patients who have a large range of illness severity

• There is an increasing need for new, more targeted treatments with alternative working mechanisms for BD I

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Additional information

Funding

This manuscript has not been funded.