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Minerva Psichiatrica 2006 March;47(1):25-34

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: Italian

Complex drug therapies in bipolar disorders: the role of atypical antipsygiotics and antidepressants

Maina G., Salvi V., Rigardetto S., Bogetto F.

Servizio per i Disturbi Depressivi e d’Ansia Dipartimento di Neuroscienze Università degli Studi di Torino, Torino

Monotherapy with a single drug is often inadequate and combination drug regimens have become usual for the treatment of bipolar disorder. Various classes of psychotropic drugs have been used in bipolar disorder in combination for a variety of indications. This article reviews the published studies regarding combination treatments between mood stabilizers and atypical antipsychotics in bipolar mania, mood stabilizers and antidepressants in bipolar depression, and augmentation strategies in the long-term maintenance phase, according to the treatment guidelines suggestions. For acute mania, the most useful combination treatments, as recommended by the existing guidelines, appear to be an antipsychotic drug with a mood-stabilizer: risperidone, olanzapine, quetiapine and ziprasidone have been studied as adjunctive treatments to lithium, valproate and less frequently carbamazepine through several randomized, double-blind, placebo-controlled studies. For acute bipolar depression, it seems useful to add an antidepressant to a mood stabilizer, although large randomized, controlled studies with modern antidepressants in bipolar depression have not been performed yet. Controlled combination studies of mood-stabilizers in the maintenance treatment phase suggest efficacy over monotherapy in recurrence-prevention only for olanzapine; other antipsychotics may prove useful albeit controlled data in the long-term are lacking. In conclusion, given the complex nature of bipolar disorders and the frequent need for combination treatment regimens, data regarding combination studies in bipolar disorder are still poor and controlled combinations are required. Increased attention should be given to study combination treatments in all phases of bipolar illness to determine the most efficacious and safest combinations.