The Pharmaceutical Journal
Vol 269 No 7228 p860
14 December 2002

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College of Mental Health Pharmacists/Industrial Pharmacists Group summary

Comparative studies of mood stabilisers are needed

Treatment of bipolar disorder is an area of major growth and development after decades of neglect, said Guy Goodwin, professor of psychiatry, University of Oxford.

Because it is a recurrent and severe condition, imposing a major burden on patients and their families, there is probably a consensus that any patient with bipolar I disorder is likely to benefit from maintenance treatment after acute mania with an appropriate and effective drug.

Although for many years treatment had to be with lithium, or a classical antipsychotic or both, we have now moved into an era of considerable uncertainty, said Professor Goodwin. We are spoiled for choice by a large menu of possible drugs claiming to stabilise mood in continuing and maintenance treatment of bipolar I disorder. Ideally, the clinical picture, the past history, our knowledge of drug efficacy and the potential burden from side effects should allow an optimal choice to be made, he said.

He went on to explain that in practice, we have a limited evidence base on which to make an informed choice. Instead, he said, we have growing evidence for the effectiveness of continuation of drugs used in acute treatment, some post-hoc evidence that particular clinical states, specifically mixed mania, may respond preferentially to particular mood stabilisers and the pragmatic fact that, although monotherapy may be the ideal, combined pharmacological treatment is increasingly the rule.

Instead of a choice based on the force of competing marketing claims, there is a need for pragmatic comparative studies of different mood stabilisers individually and in combination, concluded Professor Goodwin.
— Contributed.