Evidence-based Pharmacological Treatment in the Maintenance Phase of the Type I Bipolar Disorder: Anticonvulsants or Antipsychotics?
Introduction Type I bipolar disorder (BDI) is characterized by a chronic evolution, with recurrent mood episodes that severely disrupt the overall functionality and quality of patients’ life. An adequate maintenance treatment is necessary to prevent relapses and to improve the functional prognosis...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2022-06-01
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| Series: | European Psychiatry |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S092493382201029X/type/journal_article |
| Summary: | Introduction
Type I bipolar disorder (BDI) is characterized by a chronic evolution, with recurrent mood episodes that severely disrupt the overall functionality and quality of patients’ life. An adequate maintenance treatment is necessary to prevent relapses and to improve the functional prognosis of these patients.
Objectives
To find data regarding the most evidence-based therapeutic strategies in the maintenance phase of BDI.
Methods
A literature review was performed through the main electronic databases (PubMed, CINAHL, SCOPUS, EMBASE) using the search paradigm “type I bipolar disorder” AND “mood stabilizers” AND “antipsychotics” AND “anticonvulsants”. All papers published between January 2000 and August 2021 were included.
Results
The main recommendation is to continue in the maintenance phase the same medication that has proven its efficacy and tolerability in the acute phase. In BDI the most evidence-supported pharmacological approaches for the maintenance phase were lithium, valproate, lamotrigine, and carbamazepine as anticonvulsants/mood stabilizers, as well as olanzapine, quetiapine, and aripiprazole as antipsychotics. Lithium and valproate have been associated with positive influence over neuroplasticity, while antipsychotics have considerably higher metabolic adverse events. Monotherapy is recommended, but drugs associations are frequently met in clinical practice. There are no consistent data about the superiority of one class over the other, but lithium has a proven effect of decreasing the suicide rate in this population.
Conclusions
Both anticonvulsants and antipsychotics are used in the maintenance phase of the BDI, without significant differences in the efficacy rates. However, benefits and risks should be weighted for each class and each individual agent recommended.
Disclosure
No significant relationships.
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| ISSN: | 0924-9338 1778-3585 |