14. Complex Combination Therapy for Long-Term Stability in Bipolar Disorder

  1. Hagop S. Akiskal3 and
  2. Mauricio Tohen4
  1. Robert M. Post1,2

Published Online: 13 APR 2011

DOI: 10.1002/9780470975114.ch14

Bipolar Psychopharmacotherapy: Caring for the Patient, Second Edition

Bipolar Psychopharmacotherapy: Caring for the Patient, Second Edition

How to Cite

Post, R. M. (2011) Complex Combination Therapy for Long-Term Stability in Bipolar Disorder, in Bipolar Psychopharmacotherapy: Caring for the Patient, Second Edition (eds H. S. Akiskal and M. Tohen), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9780470975114.ch14

Editor Information

  1. 3

    International Mood Center, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0603, USA

  2. 4

    Department of Psychiatry, Division of Mood and Anxiety Disorders, University of Texas Health Science Centre at San Antonio, 7730 Floyd Curl Drive, San Antonio, TX 78229, USA

Author Information

  1. 1

    The George Washington University, 5415 West Cedar Lane, Suite 201B, Bethesda, MD 20814, USA

  2. 2

    Bipolar Collaborative Network, Bethesda, MD, USA

Publication History

  1. Published Online: 13 APR 2011
  2. Published Print: 15 APR 2011

ISBN Information

Print ISBN: 9780470747216

Online ISBN: 9780470975114

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Keywords:

  • rapid cycling;
  • anxiety disorders;
  • alcohol and substance abuse;
  • complex combination therapy;
  • psychoeducation;
  • mood charting;
  • childhood-onset bipolar disorder;
  • mood stabilizers;
  • atypical antipsychotics;
  • neurotrophic factors

Summary

There is a disconnect between FDA approvals for monotherapy or dual combination therapy in prophylaxis (based on superiority to placebo) and the clinical goals of achieving and maintaining long-term remission, which typically require more complicated treatment regimens, averaging three medications. This disconnect is particularly evident in the treatment of more representative patients with bipolar illness who often have several comorbidities, each requiring off-label prescription and assessment of treatment effectiveness that go beyond “evidence-based” guidelines. Systematic monitoring of mood, sleep, comorbidities, and side effects to evaluate effectiveness of medications and their combinations should be a critical component of psychotherapeutic/educational approaches to the illness. Other treatment principles for achieving better long-term outcomes are outlined in this chapter. Currently practiced routine care of patients with bipolar illness is often delayed and inadequate; a new era of more concerted research and rigorous treatment is required.