Psychiatr. praxi 2018; 19(3): 102-105 | DOI: 10.36290/psy.2018.021

Resistance in maintenance treatment of bipolar disorder

MUDr. Tomáš Novák, Ph.D.

Národní ústav duševního zdraví, Klecany

Effective and well-tolerated maintenance treatment is a major goal in a management of bipolar disorder (BD), but is still achievedonly in a minority of the patients. One of the main potentially reversible factor influencing treatment outcome is a poor adherence.The implementation of psychoeducation and other psychosocial interventions is therefore considered to be an importatnt stepin long-term treatment. Although lithium remains first choice as maintenance treatment for BD following the most of guidelines,in clinical practice is still used insufficiently. On the other hand, in spite of limited evidence, a substantial part of patients receiveantidepressants beyond depressive episodes. Addressing the treatment resistance, lithium monotherapy or as an add-on treatmentand tapering off antidepressants should be the first steps to be considered. A strategy of maintaining monotherapies in long-termtreatment with temporary combinations only in case of manic or depressive episodes is rarely followed despite generally recommendedas preferable. However, if monotherapies are consistently failing, then the combination therapy is warranted, lithiumor anticonvulsants with atypical antipsychotics (quetiapine, olanzapine, aripiprazole, ziprazidone or risperidone) are preferredchoice. For severely ill or poorly adherent patients clozapine, pregabalin, and long-acting antipsychotics could be of interest, butevidence in treatment-resistant BD is still inconclusive.

Keywords: bipolar disorder, maintenance therapy, treatment resistant bipolar disorder, lithium, treatment adherence

Published: October 15, 2018  Show citation