Evidence-based pharmacotherapy of bipolar disorder

© Cambridge University Press 2012. Introduction Recent years have seen a substantial expansion of the evidence base guiding the pharmacotherapy of bipolar disorder. Bipolar disorder has traditionally been relatively neglected in the research literature (Clement et al., 2003), despite comprising a major source of disability worldwide (Lopez et al., 2006), and being associated with higher rates of relapse than unipolar illness (Angst, 1995; Winokur et al., 1993). Two threads contribute to an improved evidence base to guide pharmacological management. On the one hand, the increasing availability of systematic reviews and meta-analyses allows the existing literature to be better understood. Furthermore, independent, high-quality, randomized controlled trials have begun to provide answers to some of the important clinical questions in the management of both acute episodes of illness (Sachs et al., 2003; van der Loos et al., 2009), and in prevention of relapse (Geddes et al., 2010). While this review restricts itself to the pharmacotherapy of bipolar disorder, it is, of course, important to recognize that pharmacological agents need to be delivered as part of a coherent package of care that may also involve specific psychological therapies (Beynon et al., 2008) and other psychological and social support. Bipolar disorder is also commonly accompanied by substantial comorbidity, including high rates of anxiety disorders and also of substance and alcohol-use disorders (Simon et al., 2004). While the management of these other disorders is beyond the scope of this review, these are important to assess and treat where appropriate.