Guidelines ease confusion about drug treatments
Guidelines ease confusion about drug treatments
Experts help you sort options for bipolar disorder
The overwhelming number of new pharmacologic treatment options for bipolar disorder made a revision of an earlier 1996 consensus guideline mandatory, say national experts on bipolar disorder. The experts participated in a consensus panel supported by Comprehensive NeuroScience in White Plains, NY, and unrestricted educational grants from nine pharmaceutical companies.
The new guidelines, "Medication Treatment of Bipolar Disorder 2000," published in the April 2000 issue of Postgraduate Medicine Special Report, represent a consensus of 50 psychiatric experts. The guidelines are based on clinical experience as well as knowledge of the published data. They also help identify bipolar disorder by making the experience of psychiatrists available to physicians’ offices.
"On average, people with bipolar disorder see three to four physicians before they receive a correct diagnosis," says Gary S. Sachs, MD, director of Partners Bipolar Treatment Center at Massachusetts General Hospital and assistant professor of psychiatry at Harvard Medical School in Cambridge, MA. "One reason new guidelines will prove to be so useful is that once the correct diagnosis is made, appropriate treatment can be determined to better help patients manage their symptoms."
"With these guidelines in their offices, all physicians will have useful information to help them make important diagnosis and treatment decisions. Years of experience are behind the guidelines, and physicians can rely on this tool to provide up-to-date information," adds John P. Dougherty, MD, adjunct professor of psychiatry with the Weill Medical College at Cornell University in Ithaca, NY.
To develop the new guidelines, a survey based on peer-reviewed literature asked about more than 1,200 options for psychopharmacologic interventions in 48 specific clinical situations. The questions asked experts about appropriateness of treatment in situations using a scale of one to nine in which one equaled "extremely inappropriate" and nine equaled "extremely appropriate." The broad range of treatment options included classes of medications, dosing tactics, and specific drug selection.
The survey was sent to national experts on bipolar disorder. The consensus panel used their responses to develop the guidelines, which include the following:
• Use a mood stabilizer in all treatment phases.
— Divalproex sodium and lithium are the core choices for both acute and preventive treatment.
— One of those mood stabilizers should be tried first when monotherapy is desired, in combination when either has failed, and as the foundation upon which other medications are layered.
• Mania or depression with rapid cycling should be treated initially with a mood stabilizer alone, preferably divalproex sodium, for either acute phase or prevention.
• Atypical antipsychotics, such as olanzapine and risperidone, are generally preferred to the older antipsychotics as adjunct therapy when a psychosis accompanies mania or depression.
• Mild depression should be treated with mood stabilizer monotherapy initially.
• Severe depression should be treated from the start with an antidepressant and a mood stabilizer.
The impact of bipolar disorder on families and friends can be devastating, note experts. Family and friends are often uncertain about the nature of the illness and how to treat it. A small section within the guidelines, "Treatment of Bipolar Disorder: A Guide for Patients and Families," answers some of the most commonly asked questions about bipolar disorder in laymen’s terms. This section explains symptoms, causes, treatments, and medications for bipolar disorder. Copies of this section can be obtained by contacting the National Alliance for the Mentally Ill (NAMI) in Arlington, VA, or the National Depressive and Manic-Depressive Association (NDMDA) in Chicago.
"Bipolar disorder is a serious, potentially fatal illness. Although effective treatments exist, there is an average lapse of eight years from onset of symptoms to treatment. These guidelines will help physicians accurately diagnose the illness and meet the critical need for appropriate treatment," says Lydia Lewis, executive director of NDMDA.
The full texts of the guidelines and the patient and family guide are available on the Internet at www.psychguides.com. Reprints of the "Medication Treatment of Bipolar Disorder 2000" also are available by sending requests with a shipping and handling fee of $5 per copy to: AdMail, 840 Access Road, Stratford, CT 06615. For pricing of bulk orders of 50 copies or more, call (914) 997-4008. For the patient and family guide, call NAMI at (800) 950-6264, or NDMDA at (800) 826-3632.
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