Pharmacological Therapies in Bipolar Disorder: a Review of Current Treatment Options.

BACKGROUND: Bipolar disorder is a mental illness characterised by periods of elevated mood alternating with periods of depression. Long-term relapse prevention in bipolar disorder is challenging, with a significant number of patients relapsing following the initial stabilisation of mood. Initial treatment of the condition is complex and usually occurs in secondary care. Whilst there is no known cure for bipolar disorder, several therapies have been found to be effective in both managing acute episodes and sustaining long-term remission. The key pharmacological therapies in bipolar disorder are lithium salts, antiepileptics and antipsychotics and these will be the focus of this review. AIM: This review seeks to outline the key common pharmacological therapies used in the treatment and relapse prevention of this condition. METHODS: A MEDLINE search was performed, and the available literature was subsequently analysed, including meta-analyses, reviews and original clinical trials. RESULTS: Management strategies can be subdivided into treating acute presentations of mania and depression and maintaining long-term remission. The extensive side effect profile of several antipsychotics means that there are certain patient groups for whom they may be intolerable or contraindicated. Lithium emerges as a highly efficacious maintenance therapy but retains the burden of therapeutic drug monitoring. Antiepileptics play a crucial role in maintaining remission but are linked to serious, albeit rare, side effects. CONCLUSION: Despite the efficacy of the medications discussed in this article, their underlying mechanisms of action remain to be fully elucidated. Nonetheless, these key therapies continue to be essential tools in the management of bipolar disorder.

Is Electroconvulsive Therapy any More Effective than Simulated Electroconvulsive Therapy in Treatment-Resistant Depression?

BACKGROUND: Electroconvulsive therapy (ECT) fell out of favour towards the end of the 20th century with the advent of effective and well-tolerated antidepressants. It is now experiencing somewhat of a 'renaissance' in England, with an 11 percent increase in the number of ECT treatments carried out in 2015-16 compared with 2012-13, which represents approximately 2,000 additional treatments. AIMS: This paper seeks to examine clinical trials comparing the efficacy of real ECT with simulated ECT in treatment-resistant depression (TRD) to determine whether the resurgence of ECT in recent years is justified. METHODS: A PubMed search was performed to identify clinical trials comparing real ECT with simulated ECT. 6 trials met the inclusion criteria. These were then analysed, and their methodology assessed. RESULTS: 5 out of the 6 trials found real ECT to have a greater antidepressant effect than simulated ECT. The trial that showed no significant difference used a unilateral electrode placement. Analysis revealed significant weaknesses in the trials. CONCLUSIONS: There is clear evidence that real ECT has a greater antidepressant effect than simulated ECT when a bilateral electrode placement is used, despite the weaknesses identified in the trials. Continued use of ECT to treat TRD in England and other countries should be encouraged. Further research is needed to better understand its mechanism of action and refine the techniques used.