Bipolar depression: a major unsolved challenge
Ross J. Baldessarini,Ross J. Baldessarini,Gustavo H. Vazquez,Gustavo H. Vazquez,Leonardo Tondo,Leonardo Tondo +5 more
TLDR
Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.Abstract:
Depression in bipolar disorder (BD) patients presents major clinical challenges. As the predominant psychopathology even in treated BD, depression is associated not only with excess morbidity, but also mortality from co-occurring general-medical disorders and high suicide risk. In BD, risks for medical disorders including diabetes or metabolic syndrome, and cardiovascular disorders, and associated mortality rates are several-times above those for the general population or with other psychiatric disorders. The SMR for suicide with BD reaches 20-times above general-population rates, and exceeds rates with other major psychiatric disorders. In BD, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, time depressed, and hospitalization. Lithium may reduce suicide risk in BD; clozapine and ketamine require further testing. Treatment of bipolar depression is far less well investigated than unipolar depression, particularly for long-term prophylaxis. Short-term efficacy of antidepressants for bipolar depression remains controversial and they risk clinical worsening, especially in mixed states and with rapid-cycling. Evidence of efficacy of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefit, but valproate and carbamazepine are inadequately tested and carry high teratogenic risks. Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.read more
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Lithium’s antiviral effects: a potential drug for CoViD-19 disease?
Andrea Murru,Mirko Manchia,Mirko Manchia,Tomas Hajek,René Ernst Nielsen,Janusz K. Rybakowski,Gabriele Sani,Gabriele Sani,Thomas G. Schulze,Leonardo Tondo,Leonardo Tondo,Michael Bauer +11 more
TL;DR: Lithium presents a clear antiviral activity demonstrated at preclinical level, but that remains to be confirmed in clinical settings, and the pleiotropic mechanisms of action of lithium may provide an insight for its possible use as antiviral agent targeting specific pathways.
Journal ArticleDOI
Lithium Treatment Over the Lifespan in Bipolar Disorders.
TL;DR: The evidence on efficacy in general, from relapse prevention to acute anti-manic treatment and its role in treating mood episodes with mixed features and bipolar depression and lithium's adverse effects are summarized.
Journal ArticleDOI
Overview of lithium's use: a nationwide survey
Xabier Pérez de Mendiola,Xabier Pérez de Mendiola,Diego Hidalgo-Mazzei,Eduard Vieta,Ana González-Pinto,Ana González-Pinto +5 more
TL;DR: The use of lithium in Spain is in line with the recommendations of the main international clinical guidelines and current scientific literature, based on a nationwide survey of psychiatrists relevant issues of the use of Lithium salts in BD.
Journal ArticleDOI
Preventing new episodes of bipolar disorder in adults: Systematic review and meta-analysis of randomized controlled trials.
Anastasiya Nestsiarovich,Anastasiya Nestsiarovich,Christopher Gaudiot,Ross J. Baldessarini,Eduard Vieta,Yiliang Zhu,Mauricio Tohen +6 more
TL;DR: In this paper, a systematic review and meta-analysis aims to consolidate the evidence from the highest quality randomized controlled trials (RCTs) published up to July 2021, overcoming the limitations of earlier reviews.
Journal ArticleDOI
Preventing new episodes of bipolar disorder in adults: Systematic review and meta-analysis of randomized controlled trials
TL;DR: In this article , a systematic review and meta-analysis aims to consolidate the evidence from the highest quality randomized controlled trials (RCTs) published up to July 2021, overcoming the limitations of earlier reviews.
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TL;DR: It is suggested that clozapine therapy significantly reduces suicidal behavior in patients with schizophrenia and schizoaffective disorder at high risk for suicide, and use of clozAPine in this population should lead to a significant reduction in suicidal behavior.
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