Reply to correspondence to "Algorithm or not for pharmacological treatment of mania during hospitalisation"

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Abstract

Licht et al. advocate for the traditional sequential treatment of inpatient mania with an antipsychotic and, if necessary, an adjunctive benzodiazepine, and, in select cases, with valproate and potentially lithium at a later stage, arguing for “a nuanced approach to treatment algorithms that prioritises patient-centred care” [1]. Such an approach may be fruitful for clinical experts in bipolar disorder but leaves younger and less experienced clinicians with complex and, in many cases, unclear choices. Thus, a total of nine drugs are all recommended as first-line treatment options with level 1 comparable efficacy evidence (Cohen’s d 0.32-0.66; small to medium effect size) by the 2018 guideline from the Canadian Network for Mood and Anxiety Treatments (CANMAT) and the International Society for Bipolar Disorders (ISBD) 2018. These nine drugs are lithium, divalproex, aripiprazole, paliperidone, risperidone, asenapine, olanzapine, quetiapine and cariprazine [2]. Conversely, it is well known from clinical trials that only approx. 50% of manic patients will respond to monotherapy within 3-4 weeks [2]. In short, the individual clinician is poorly guided by RCTs and is left with a range of difficult choices.
OriginalsprogEngelsk
ArtikelnummerA300008
TidsskriftDanish Medical Journal
Vol/bind71
Udgave nummer9
Antal sider2
ISSN2245-1919
DOI
StatusUdgivet - 2024

Bibliografisk note

Publisher Copyright:
Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.

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