Bipolar disorders: new approaches to therapy

This article reviews the evidence supporting different somatic treatment strategies in the acute and maintenance treatment phases of bipolar disorder. Bipolar affective disorder is a chronic disorder with a life time incidence of 0.3 - 1.5/100 [1]. Severe affective disorder is associated with a risk of completed suicide of 6 - 15% [2,3]. Traditionally, bipolar disorder has been considered as an episodic disorder with good inter-episode recovery [4]. This is being increasingly challenged with patients demonstrating social, marital, occupational and cognitive dysfunction, even when euthymic [5]. The management of bipolar disorder should be considered in the context of; the type of episode, this may be manic, depressed or mixed; the degree and rate of recovery; the cycling frequency and precipitant, if any, for recurrence and the onset and evolution of the underlying illness. On average, four episodes occur every 10 years. However 13 - 24% of patients develop rapid cycling disorder, in which four or more episodes occur within a year. Patients with bipolar disorder often have co-morbid anxiety and substance abuse. Moreover, axis I co-morbidity may be associated with an earlier age at onset and worsening course of bipolar illness. [6]. Axis II co-morbidity is also common, this was highlighted in a study by Kay and colleagues who, after excluding patients with a history of alcohol misuse, demonstrated axis II co-morbidity in almost a quarter of euthymic bipolar patients [7]. Good practice relies on an overall management plan that incorporates somatic, psychological and social approaches. This paper will focus on one element of such a plan, the currently available somatic management strategies for bipolar disorder.