Balanced efficacy, safety, and tolerability recommendations for the clinical management of bipolar disorder

Authors

  • Gin S Malhi,

    1. CADE Clinic, Department of Psychiatry, Royal North Shore Hospital
    2. Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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  • Danielle M Bargh,

    1. CADE Clinic, Department of Psychiatry, Royal North Shore Hospital
    2. Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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  • Roger McIntyre,

    1. Department of Psychiatry
    2. Department of Pharmacology, University of Toronto
    3. Mood Disorders Psychopharmacology Unit, University Health Network
    4. Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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  • Michael Gitlin,

    1. Department of Psychiatry, Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
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  • Mark A Frye,

    1. Department of Psychiatry, Mayo Mood Clinic and Research Program, Mayo College of Medicine, Rochester MN, USA
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  • Michael Bauer,

    1. Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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  • Michael Berk

    1. School of Medicine, Deakin University, Geelong
    2. Orygen Youth Health Research Centre, Centre for Youth Mental Health
    3. Department of Psychiatry, University of Melbourne, Parkville
    4. Barwon Health and the Geelong Clinic, Swanston Centre, Geelong
    5. The Mental Health Research Institute of Victoria, Parkville, VIC, Australia
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Corresponding author:
Professor Gin S. Malhi
Department of Psychiatry
University of Sydney
CADE Clinic
Level 5, Building 36
Royal North Shore Hospital
St. Leonards, NSW 2065, Australia
Fax: +61 2 9926-7730
E-mail: gin.malhi@sydney.edu.au

Abstract

Malhi GS, Bargh DM, McIntyre R, Gitlin M, Frye MA, Bauer M, Berk M. Balanced efficacy, safety, and tolerability recommendations for the clinical management of bipolar disorder. Bipolar Disord 2012: 14 (Suppl. 2): 1–21. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S.

Objective:  To provide practical and clinically meaningful treatment recommendations that amalgamate clinical experience and research findings for each phase of bipolar disorder.

Methods:  A comprehensive search of the literature was undertaken using electronic database search engines (Medline, PubMed, Cochrane reviews) using key words (e.g., bipolar depression, mania, treatment). All relevant randomised controlled trials were examined, along with review papers, meta-analyses, and book chapters known to the authors. In addition, the recommendations from accompanying papers in this supplement have been distilled and captured in the form of summary boxes. The findings, in conjunction with the clinical experience of international researchers and clinicians who are practiced in treating mood disorders, formed the basis of the treatment recommendations within this paper.

Results:  Balancing clinical experience with evidence informed and lead to the development of practical clinical recommendations that emphasise the importance of safety and tolerability alongside efficacy in the clinical management of bipolar disorder.

Conclusions:  The current paper summarises the treatment recommendations relating to each phase of bipolar disorder while providing additional, evidence-based, practical insights. Medication-related side effects and monitoring strategies highlight the importance of safety and tolerability considerations, which, along with efficacy information, should be given equal merit.

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