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Pharmacological Treatment of the Maintenance Phase of Bipolar Depression: Efficacy and Side Effects

  • Keming GaoEmail author
  • Renrong Wu
  • Joseph R. Calabrese
Chapter
Part of the Milestones in Drug Therapy book series (MDT)

Abstract

To prevent relapse/recurrence of mood episodes in bipolar disorder (BD), medications must demonstrate efficacy in preventing both manic/mixed/hypomanic and depressive relapses/recurrences. Most maintenance treatment studies of BD have continued using relapse-prevention designs to preserve assay sensitivity despite their limited generalizability. This chapter focuses on all traditional efficacy measures including time to intervention for relapse/recurrence of any mood episodes, manic/mixed episodes, and depressed episodes. For safety, we have focused on short- and long-term side effects, especially ≥7 % weight gain. To date, lithium, lamotrigine, and quetiapine have been investigated in both manic and depressive index episodes. Divalproex, olanzapine, aripiprazole, paliperidone, and risperidone long-acting injections have been evaluated in manic/mixed index episodes. Both time-to-event results and cumulative risk for relapse/recurrence showed that only quetiapine demonstrated bimodal efficacy in preventing both depressive and manic/mixed/hypomanic relapses. The other medications were only efficacious for preventing manic/mixed relapses or more effective in preventing manic/mixed relapses than depressive relapses. Short-term side effects varied widely among the aforementioned medications, but newly emergent side effects during long-term treatment were relatively rare. With the exception of ziprasidone, significantly higher rates of ≥7 % weight gain were observed with all other antipsychotics. The short- and long-term side effects suggest that relapse-prevention studies also inflate the safety and tolerability of active treatments.

Keywords

Bipolar depression Efficacy Relapse-prevention design Time-to-event analysis Maintenance Common side effects 

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Copyright information

© Springer International Publishing Switzerland (outside the USA)  2016

Authors and Affiliations

  1. 1.Department of PsychiatryMood and Anxiety Clinic in Mood Disorders Program, University Hospitals Case Medical Center, Case Western Reserve University School of MedicineClevelandUSA
  2. 2.Institute of Mental Health of Second Xiangya Hospitals of Central South UniversityHunanP.R. China

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