Clinical Correlates of Sustained Response to Individual Drugs Used in Naturalistic Treatment of Patients with Bipolar Disorder

http://www.sciencedirect.com/science/article/pii/S0010440X16000043

Abstract
Objective

To report use and treatment success rates of medications for bipolar disorder as a function of patients’ clinical characteristics.
Method

Outpatients with bipolar illness diagnosed by SCID were rated by research assistants on the NIMH-LCM and those that had an good response for at least 6 months (much or very much improved on the CGI-BP) were considered responders (treatment “success”). Clinical characteristics associated with treatment response in the literature were examined for how often a drug was in a successful regimen when a given characteristic was either present or absent.

Results

Lithium was less successful in those with histories of rapid cycling, substance abuse, or (surprisingly) a positive parental history of mood disorders. Valproate was less successful in those with ≥ 20 prior episodes. Lamotrigine (LTG) was less successful in those with a parental history of mood disorders or in BP-I compared to BP-II disorder. Antidepressants (ADs) had low success rates, especially in those with a history of anxiety disorders. Benzodiazepines had low success rates in those with child abuse, substance use, or ≥ 20 episodes. Atypical antipsychotics were less successful in the presence of rapid cycling, ≥ 20 prior episodes, or a greater number of poor prognosis factors.

Conclusion

Success rates reflect medications used in combination with an average of two other drugs during naturalistic treatment and thus should be considered exploratory. However, the low long-term success rates of drugs (even when used in combination with others) that occurred in the presence of many very common clinical characteristics of bipolar illness speak to the need for the development of alternative treatment strategies.

#studie #behandling #PPF

Tack, inte så uppmuntrande kanske, men det förstärker känslan man får när man hör många berätta att det för långt ifrån alla bara är att "ta ett litiumpiller och leva helt normalt", även om det förstås också förekommer.

Det är viktigt att komma ihåg, som också står i full text, att det ofta förekommer det kombinationsbehandlingar (det är också inräknat), samt att när man tittat på grupperna "antidepressiva" och "atypiska neuroleptika" så finns det skillnader inom läkemedelsgruppen. Det skiljde sig i dessutom både användandet och success rate mellan Europa och USA för i princip varje medicin.

Sammanfattningsvis så ser det ändå ut så här:

We found that lithium had the highest overall “success rate” of 49.3%, i.e. lithium was involved in the treatment regimen of the good responders and those who were Well on Entry compared to its use in the non-responders [10] and [11]. The next drugs with the best overall success rate were carbamazepine at 39.9%, followed by valproate (34.8%), any atypical (20.7%), any antidepressant (17.8%), and any typical antipsychotic (11.8%).