Review identifies most effective treatments for bipolar disorder

Researchers have reviewed 77 meta-analyses spanning 116 different bipolar disorder treatments and identified the most effective ones across age groups and mood phases.

Bipolar disorder is a mental disorder, characterised by extreme swings in mood, energy levels and activity. The disorder can causes phases of depression marked by a low mood and energy or mania, in which mood and activity levels tend to be high.

Researchers, led by those from The Ottawa Hospital in Canada and universities in Spain, Italy, France and the UK, have created EBI-BD (Evidence Based Interventions for Bipolar Disorder).

EBI-BD is an open-access web platform clearly presenting the impact, side effects, and strength of evidence for each treatment based on findings from the “most comprehensive” review, published in The British Medical Journal.

For bipolar depression, effective treatments for adults include cariprazine, fluoxetine and lurasidone, while those among children and teenagers were lurasidone and olanzapine with fluoxetine.

Effective interventions for mania episodes among adults include aripiprazole, haloperidol, lithium and risperidone, whereas those for children and teenagers include aripiprazole, asenapine and olanzapine.

Maintenance dose — prescribed to prevent future episodes and for long-term health — effective for adults include aripiprazole, lithium and risperidone.

“We hope clinicians will be able to use the platform with their own patients to find the best balance between efficacy and side effects, according to each patient’s needs,” author Michele De Prisco, psychiatrist and researcher at the Hospital Clínic de Barcelona and the University of Barcelona, Spain, said.

“Using the platform and its integrated preference tool, clinician and patient can decide together which treatment to consider next,” Dr De Prisco said.

Author — Jess Fiedorowicz, head and chief of mental health at The Ottawa Hospital and professor at the University of Ottawa, said medications for the mental health disorder can come with varied side effects.

“A tool that incorporates patient preferences and promotes shared decision-making can help find treatments that are a better fit,” Dr Fiedorowicz said.

Results from the review have also been used to update guidelines, including those of the International Society for Bipolar Disorders (ISBD), for the management of bipolar disorder.

The study is the first living umbrella review to include all treatment strategies assessed across any age group and phase of bipolar disorder from the largest and best meta-analyses available to date, the researchers said.

The review can be adapted rapidly as new evidence emerges and serves as a foundation for continuously improving care, which is why it is called a “living review”, they said.

“Living reviews like this one are game-changers when it comes to updating international treatment guidelines,” author Samuele Cortese, research professor at the University of Southampton, UK, said.

“Rather than taking a week to get an answer, experts can consult the website in real time during meetings for the latest evidence,” Dr Cortese said.

The authors wrote, “The EBI-BD tool can help clinicians make evidence-based, personalised treatment decisions for bipolar disorder.”