Pharmacological Approaches for Treatment-resistant Bipolar Disorder

Abstract

(from the chapter) Bipolar disorder (BD) is a serious mental illness associated with high morbidity and mortality. In contrast to earlier views that BD has a relatively favourable prognosis with good response to relatively simple treatment regimens, the emerging picture is that of a complex, often severe, disabling and even fatal illness. Many clinicians and researchers have considered such unfavourable outcomes as manifestations of treatment resistance, and working criteria for treatment resistance in BD vary considerably. A significant proportion of BD patients respond incompletely or unsatisfactorily to first-line treatments. Given the high burden of this illness, there is a pressing need to improve the clinical care of this group of patients. This chapter aims to review evidence of pharmacological options for treatment-resistant BD. There are few randomized controlled trials (RCTs) describing therapeutic options for refractory BD and some of the extant studies are limited by small sample sizes, inclusion of participants with other related conditions (e.g. bipolar I versus bipolar II disorder, unipolar depression, or schizoaffective disorder), poor randomization and blinding, variable methods of assessment, inadequate treatment durations, and scarce maintenance trials. (PsycINFO Database Record (c) 2016 APA, all rights reserved)