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.
Originalsprog | Engelsk |
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Artikelnummer | A300008 |
Tidsskrift | Danish Medical Journal |
Vol/bind | 71 |
Udgave nummer | 9 |
Antal sider | 2 |
ISSN | 2245-1919 |
DOI | |
Status | Udgivet - 2024 |
Bibliografisk note
Publisher Copyright:Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.