Daily Archives: April 23, 2018

The Good Guy

You are always a good person the day people find out you died. This phenomenon is pretty amazing actually. I suppose it stems from that old adage ‘don’t speak ill of the dead’, but it goes well beyond that. People love to talk about the good things when they hear that news, no matter what […]

Bipolar Disorder Psychopharmacology: Updated Guidelines

In March 2016, the British Association for Psychopharmacology published new bipolar disorder guidelines.

Summary by Flavio Guzman, MD below.

The complete publication is 59 pages long, so I extracted some key points that you may find useful:

• Lithium remains the most effective treatment preventing relapse and admission to hospital in bipolar I disorder (I)

• Lithium prevents relapse to mania and, less effectively, depression (I). The highest dose that produces minimal adverse reactions and effects should be employed.

• Concentrations below 0.6 mmol/L are potentially too low to be fully effective and adverse reactions and effects become important above 0.8 mmol/L.

• Lithium reduces the risk of suicide (I).

• Valproate as monotherapy has limited trial data, is somewhat less effective than lithium in the prevention of relapse.

• Valproate should not usually be considered for women of child-bearing potential (I).

• Carbamazepine as monotherapy is less effective than lithium, has little if any effect on relapse to depression and is liable to interfere with the metabolism of other drugs (I).

• Lamotrigine is effective against depression in long-term treatment (I) and should be considered where depression is the major burden of the illness (IV).