Praktické lekárnictvo 1/2016

Current pharmacotherapy of bipolar disorder

Bipolar disorder (BD) is a mental disorder characterized by significant fluctuations in mood, thinking, physical and mental activity and behaviour while in a patient typically include periods of mood disorders under clinical manifestation of depression and/or mania. We now have in terms of evidence-based medicine as a drug of first choice for the treatment of manic or mixed episodes available 7 atypical antipsychotics and 2 mood stabilizers, while for the treatment of bipolar depression we alone is no antidepressant as first choice (within the meaning of EBM). And combination therapy with an antidepressant and mood stabilizer (resp. AAP) is a risk, albeit considerably less than antidepressant monotherapy. The effective antimanic first line psychopharmacological drugs include lithium, valproic acid/ valproate, olanzapine, quetiapine, risperidone, aripiprazole, ziprasidone, asenapine and paliperidone; while carbamazepine for many pharmacological interactions and side effects become antimanikom second line. The most common drug for first line treatment of depressive episode are given quetiapine, lamotrigine, olanzapine-fluoxetine combination, also lithium, valproic acid, respectively, the combination of bupropion or an SSRI-acting anti-manic psychopharmaceutical. When BD never left untreated only current episode, we treat affective disorder usually a life-long duration. This treatment is really complicated mainstay of treatment should be solid therapeutic relationship physician and patient together with relatives for help review the warning signs through daily diaries.

Keywords: bipolar disorder, therapy, psychopharmacological drugs