The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder

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Abstract

Although clinically highly relevant, the recognition and treatment of bipolar mixed states has played only an underpart in recent guidelines. This WFSBP guideline has been developed to supply a systematic overview of all scientific evidence pertaining to the acute and long-term treatment of bipolar mixed states in adults.

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Bipolar disorder.

Iria Grande, Michael Berk, Boris Birmaher … (2016)

Bipolar disorder is a recurrent chronic disorder characterised by fluctuations in mood state and energy. It affects more than 1% of the world's population irrespective of nationality, ethnic origin, or socioeconomic status. Bipolar disorder is one of the main causes of disability among young people, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. A high prevalence of psychiatric and medical comorbidities is typical in affected individuals. Accurate diagnosis of bipolar disorder is difficult in clinical practice because onset is most commonly a depressive episode and looks similar to unipolar depression. Moreover, there are currently no valid biomarkers for the disorder. Therefore, the role of clinical assessment remains key. Detection of hypomanic periods and longitudinal assessment are crucial to differentiate bipolar disorder from other conditions. Current knowledge of the evolving pharmacological and psychological strategies in bipolar disorder is of utmost importance.

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The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders.

Aysegul Ozerdem, Jean-Michel Azorin, Ross J Baldessarini … (2013)

The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications.

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A consumer's guide to subgroup analyses.

Andrew D Oxman (1992)

The extent to which a clinician should believe and act on the results of subgroup analyses of data from randomized trials or meta-analyses is controversial. Guidelines are provided in this paper for making these decisions. The strength of inference regarding a proposed difference in treatment effect among subgroups is dependent on the magnitude of the difference, the statistical significance of the difference, whether the hypothesis preceded or followed the analysis, whether the subgroup analysis was one of a small number of hypotheses tested, whether the difference was suggested by comparisons within or between studies, the consistency of the difference, and the existence of indirect evidence that supports the difference. Application of these guidelines will assist clinicians in making decisions regarding whether to base a treatment decision on overall results or on the results of a subgroup analysis.

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Author and article information

Journal

Title: The World Journal of Biological Psychiatry

Abbreviated Title: The World Journal of Biological Psychiatry

Publisher: Informa UK Limited

ISSN (Print): 1562-2975

ISSN (Electronic): 1814-1412

Publication date Created: January 18 2018

Publication date Created: January 02 2018

Publication date (Electronic): November 03 2017

Publication date (Print): January 02 2018

Volume: 19

Issue: 1

Pages: 2-58

Affiliations

[1 ] Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK;

[2 ] Paracelsus Medical University, Nuremberg, Germany;

[3 ] Zentrum für Psychiatrie Weinsberg, Klinikum am Weissenhof, Weinsberg, Germany;

[4 ] Bipolar Disorders Programme, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain;

[5 ] Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK;

[6 ] Dept. of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA;

[7 ] Psychiatric Research Unit, Psychiatry, Aalborg University Hospital, Aalborg, Denmark;

[8 ] Clinical Department of Medicine, Aalborg University, Aalborg, Denmark;

[9 ] Department of Psychiatry, Hospital Ste. Marguerite, Marseille, France;

[10 ] Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada;

[11 ] Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia;

[12 ] Department of Psychiatry and Psychotherapy, Ludwigs-Maximilian University, Munich, Germany;

[13 ] Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria

Article

DOI: 10.1080/15622975.2017.1384850

PubMed ID: 29098925

SO-VID: f8bd0ebf-5c53-4b0e-bae2-3dcd4fee713a

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The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder

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Abstract

Related collections

Journal of the ASEAN Federation of Endocrine Societies

Most cited references 286

Bipolar disorder.

The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders.

A consumer's guide to subgroup analyses.

Author and article information

Journal

Affiliations

Article

History

Comments

Comment on this article

Similar content 1,356

Cited by 59

Most referenced authors 2,961