Pharmacological treatment of the maintenance phase of bipolar depression: focus on relapse prevention studies and the impact of design on generalizability

Abstract

The goal of pharmacological treatment of bipolar disorder is to prevent future occurrences of mood episodes. To achieve this goal, medications must demonstrate efficacy in the prevention of both manic/hypomanic and depressive relapses/recurrences. Currently, the efficacy of most pharmacological agents in the maintenance treatment of bipolar disorder has been studied using relapse prevention designs, in which only patients who tolerate and respond to a studied drug(s) in the acute phase (mania or depression) can enter the maintenance phase. Subsequently, the results from relapse prevention studies are not generalizable, not only because of the design, but also because of different index mood episodes. So far, however, only lithium and lamotrigine, and to some extent divalproex, have been investigated in both manic and depressive index episodes, while olanzapine and aripiprazole have been evaluated in manic index episodes. To facilitate the application of currently available data, this chapter will systematically examine randomized, blinded, controlled maintenance studies enrolling >=100 patients and lasting >=6 months. (PsycINFO Database Record (c) 2016 APA, all rights reserved)