Treatment for Bipolar Disorder in Adults: A Systematic Review

SYSTEMATIC REVIEW

August 7, 2018

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Purpose of Review

To assess the effectiveness of drug and nondrug therapies for treating acute mania or depression symptoms and preventing relapse in adults with bipolar disorder (BD) diagnoses, including bipolar I disorder (BD-I), bipolar II disorder (BD-II), and other types.

Key Messages

Acute mania treatment: Lithium, asenapine, cariprazine, olanzapine, quetiapine, risperidone, and ziprasidone may modestly improve acute mania symptoms in adults with BD-I. Participants on atypical antipsychotics, except for quetiapine, reported more extrapyramidal symptoms, and those on olanzapine reported more weight gain, compared with placebo.
Maintenance treatment: Lithium may prevent relapse into acute episodes in adults with BD-I.
Depression treatment: Evidence was insufficient for drug treatments for depressive episodes in adults with BD-I and BD-II.
For adults with any BD type, cognitive behavioral therapy may be no better than other psychotherapies for improving acute bipolar symptoms and systematic/collaborative care may be no better than other behavioral therapies for preventing relapse of any acute symptoms.
Stronger conclusions were prevented by high rates of participants dropping out.