Lamotrigine for bipolar disorder: translating research into clinical practice

Using Lithium in Older Age Bipolar Disorder: Special Considerations

Lithium is the gold-standard treatment for bipolar disorder, and is effective in the management of manic, depressive, and maintenance phases of bipolar disorder treatment. Despite this, the implications of lithium use in the older population remain less understood. This critical narrative review aims to better understand the impact of lithium in older age bipolar disorder (OABD), including tolerability and efficacy, based on up-to-date evidence. Relevant studies of efficacy, effectiveness, and tolerability published any time prior to May 2018 were identified using the PubMed keyword search "lithium older adult bipolar disorder" and references from recent international bipolar disorder guidelines. One randomized controlled trial was identified, the GERI-BD (Acute Pharmacotherapy in Late-Life Mania) study. This study found lithium to be effective in late-life mania and hypomania. The remaining literature examining lithium in OABD was reviewed, comprising of a number of small open-label and retrospective studies, with special considerations highlighted. In summary, there is a small yet increasing geriatric evidence base that lithium is effective in OABD. Although there can be adverse effects with lithium, it is generally well tolerated, and there are methods to minimize these risks. Further research would strengthen the evidence base for lithium therapy in OABD. In the meantime, lithium remains the gold-standard treatment for OABD.

Bipolar disorder: historic perspective, current pharmacologic treatment options and a review of quetiapine

Bipolar disorder is a complex mental illness that is frequently both under-diagnosed and under-treated. The symptoms of bipolar disorder can be confused with other medical illnesses or drug effects or may even be overlooked entirely as extreme character traits. The consequences of delayed diagnosis or misdiagnosis are potentially devastating, including loss of employment, impaired relationships and a severely impaired quality of life. This article will review the historic perspectives of bipolar disorder, the diagnostic criteria for the phases of the illness, and the pharmacologic options available to treat this condition. Quetiapine, an atypical antipsychotic, will be reviewed indepth. Based on extensive trial data, reviewed in this article, quetiapine is approved by the US Food and Drug Administration for use as monotherapy or as adjunctive therapy with other mood stabilizers for the treatment of acute manic episodes of bipolar I disorder. Clinical trials describing the efficacy of quetiapine in other phases of bipolar disorder and in other patient populations are also reviewed. A discussion of the drug profile of quetiapine includes its chemistry, availability, pharmacodynamics, pharmacokinetics and metabolism. Preclinical studies, postmarketing surveillance, safety, tolerability and regulatory issues are also evaluated. Finally, potential future directions for quetiapine are discussed, together with a review of key issues in bipolar disorder management and details of the information resources used in preparing this article.