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:
Sidor MM, McQueen GM. Antidepressants for the acute treatment of bipolar depression: a systematic review and meta-analysis. Journal of Clinical Psychiatry. 2011;72:156-67. [Comment: Antidepressant focus; 5 years old]

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]
 
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 metaanalysis. Int J Neuropsychopharmacol 2010; 13: 5–14.  [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]
 
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]
 
Geddes JR, Calabrese JR, Goodwin GM. Lamotrigine for treatment of bipolar depression: independent meta analysis and meta-regression of individual patient data from five randomised trials. Br J Psychiatry 2009; 194: 4–9.  [Comment: Single drug focus; 7 years old]
 
Sidor MM, Macqueen GM. Antidepressants for the acute treatment of bipolar depression: a systematic review and meta-analysis. J Clin Psychiatry 2011; 72: 156–167.  [Comment: Antidepressant focus; 5 years old]
 
Mania:
Cipriani A, Barbui C, Salanti G, Rendell J, Brown R, Stockton S, et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. The Lancet. 2011;378:1306-15.  [Comment: 5 years old]
 
Correll CU, Sheridan EM, DelBello MP. Antipsychotic and mood stabilizer efficacy and tolerability in pediatric and adult patients with bipolar I mania: a comparative analysis of acute, randomized, placebo-controlled trials.
Bipolar Disord 2010; 12: 116–141.  [Comment: 6 years old]
 
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]
 
Ceron-Litvoc D, Soares BG, Geddes J, Litvoc J, de Lima MS. Comparison of carbamazepine and lithium in treatment of bipolar disorder: a systematic review of randomized controlled trials. Hum Psychopharmacol 2009; 24: 19–28.  [Comment: Two drug comparison; 7 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:
Gitlin M, Frye MA. Maintenance therapies in bipolar disorders. Bipolar Disorders. 2012;14 (Suppl. 2):51-65.
 
Cipriani A, Reid K, Young AH, Macritchie K, Geddes J. Valproic acid, valproate and divalproex in the maintenance treatment of bipolar disorder. Cochrane Database of Systematic Reviews. 2013d;10:CD003196. [Comment: Fairly recent review]
 
Geddes JR, Burgess S, Hawton K, Jamison K, Goodwin GM. Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. American Journal of Psychiatry. 2004;161:217-22.  [Comment: Single drug focus; 12 years old]
 
Vieta E, Gunther O, Locklear J et al. Effectiveness of psychotropic medications in the maintenance phase of bipolar disorder: a meta-analysis of randomized controlled trials. Int J Neuropsychopharmacol 2011; 14: 1029–1049.  [Comment: 5 years old]
 
Fountoulakis KN, Vieta E, Schmidt F. Aripiprazole monotherapy in the treatment of bipolar disorder: a metaanalysis. 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]
 
Beynon S, Soares-Weiser K, Woolacott N, Duffy S, Geddes JR. Pharmacological interventions for the prevention of relapse in bipolar disorder: a systematic review of controlled trials. J Psychopharmacol 2009; 23: 574–591. [Comment: 7 years old]
 
Cipriani A, Rendell J, Geddes JR. Olanzapine in the long-term treatment of bipolar disorder: a systematic review and meta-analysis. J Psychopharmacol 2010; 24: 1729–1738. [Comment: Single drug focus; 6 years old]
 
Ceron-Litvoc D, Soares BG, Geddes J, Litvoc J, de Lima MS. Comparison of carbamazepine and lithium in treatment of bipolar disorder: a systematic review of randomized controlled trials. Hum Psychopharmacol 2009; 24: 19–28.  [Comment: Two drug comparison; 7 years old]

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