Norma Verdolini1, Diego Hidalgo-Mazzei1,2, Laura Del Matto3, Michele Muscas4, Isabella Pacchiarotti1, Andrea Murru1, Ludovic Samalin5,6, Alberto Aedo7, Mauricio Tohen8, Heinz Grunze9, Allan H Young2, André F Carvalho10,11, Eduard Vieta1. 1. Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. 2. Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. 3. Department of Molecular Medicine, University of Siena, School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy. 4. Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy. 5. Department of Psychiatry, CHU Clermont-Ferrand, University of Auvergne, Clermont-Ferrand, France. 6. Fondation FondaMental, Hôpital Albert Chenevier, Créteil, France. 7. Bipolar Disorders Unit, Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. 8. Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA. 9. Nuremberg & Psychiatrie, Paracelsus Medical University, Schwäbisch Hall, Germany. 10. Department of Psychiatry, University of Toronto, Toronto, ON, Canada. 11. Centre of Addiction and Mental Health (CAMH), Toronto, ON, Canada.
Abstract
OBJECTIVES: This systematic review aimed at providing a critical, comprehensive synthesis of international guidelines' recommendations on the long-term treatment of bipolar disorder type I (BD-I). METHODS: MEDLINE/PubMed and EMBASE databases were searched from inception to January 15th, 2019 following PRISMA and PICAR rules. International guidelines providing recommendations for the long-term treatment of BD-I were included. A methodological quality assessment was conducted with the Appraisal of Guidelines for Research and Evaluation-AGREE II. RESULTS: The final selection yielded five international guidelines, with overall good quality. The evaluation of applicability was the weakest aspect across the guidelines. Differences in their updating strategies and the rating of the evidence, particularly for meta-analyses, randomized clinical trials (RCTs) and observational studies, could be responsible of some level of heterogeneity among recommendations. Nonetheless, the guidelines recommended lithium as the 'gold standard' in the long-term treatment of BD-I. Quetiapine was another possible first-line option as well as aripiprazole (for the prevention of mania). Long-term treatment should contemplate monotherapy, at least initially. Clinicians should check regularly for efficacy and side effects and if necessary, switch to first-line alternatives (i.e. Valproate), combine first-line compounds with different mechanisms of action or switch to second-line options or combinations. CONCLUSIONS: The possibility to monitor improvements in long-term outcomes, namely relapse prevention and inter-episode subthreshold depressive symptoms, based on the application of their recommendations is an unmet need of clinical guidelines. In terms of evidence of clinical guidelines, there is a need for more efficacious treatment strategies for the prevention of bipolar depression.
OBJECTIVES: This systematic review aimed at providing a critical, comprehensive synthesis of international guidelines' recommendations on the long-term treatment of bipolar disorder type I (BD-I). METHODS: MEDLINE/PubMed and EMBASE databases were searched from inception to January 15th, 2019 following PRISMA and PICAR rules. International guidelines providing recommendations for the long-term treatment of BD-I were included. A methodological quality assessment was conducted with the Appraisal of Guidelines for Research and Evaluation-AGREE II. RESULTS: The final selection yielded five international guidelines, with overall good quality. The evaluation of applicability was the weakest aspect across the guidelines. Differences in their updating strategies and the rating of the evidence, particularly for meta-analyses, randomized clinical trials (RCTs) and observational studies, could be responsible of some level of heterogeneity among recommendations. Nonetheless, the guidelines recommended lithium as the 'gold standard' in the long-term treatment of BD-I. Quetiapine was another possible first-line option as well as aripiprazole (for the prevention of mania). Long-term treatment should contemplate monotherapy, at least initially. Clinicians should check regularly for efficacy and side effects and if necessary, switch to first-line alternatives (i.e. Valproate), combine first-line compounds with different mechanisms of action or switch to second-line options or combinations. CONCLUSIONS: The possibility to monitor improvements in long-term outcomes, namely relapse prevention and inter-episode subthreshold depressive symptoms, based on the application of their recommendations is an unmet need of clinical guidelines. In terms of evidence of clinical guidelines, there is a need for more efficacious treatment strategies for the prevention of bipolar depression.
Authors: Vincenzo Oliva; Michele De Prisco; Maria Teresa Pons-Cabrera; Pablo Guzmán; Gerard Anmella; Diego Hidalgo-Mazzei; Iria Grande; Giuseppe Fanelli; Chiara Fabbri; Alessandro Serretti; Michele Fornaro; Felice Iasevoli; Andrea de Bartolomeis; Andrea Murru; Eduard Vieta; Giovanna Fico Journal: J Clin Med Date: 2022-07-06 Impact factor: 4.964