Psychiatric Times.
Clinical
Antipsychotic Combination Strategies in Bipolar Disorder:
Strategies to Maximize Treatment Adherence
By David J. Muzina, MD and Martha Sajatovic, MD |
April 14, 2009
Dr Muzina is director of the Center for Mood Disorders Treatment and Research in the department of psychiatry at the Cleveland Clinic in Cleveland. Dr Sajatovic is professor of psychiatry at Case Western Reserve University School of Medicine in Cleveland and director of geropsychiatry at University Hospitals Case Medical Center in Cleveland. Dr Muzina reports that he is on the speakers’ bureau for AstraZeneca, Bristol-Myers Squibb, Pfizer, Sepracor, and Wyeth; and that he is a member of the scientific advisory board for AstraZeneca. Dr Sajatovic reports that she has received research funding from AstraZeneca, GlaxoSmithKline, and the NIMH; and she is a consultant for GlaxoSmithKline, Cognition Group, and AstraZeneca.
Combination therapies are widely used in clinical settings, yet there has not been extensive research on key outcome domains, such as adherence or quality of life for many commonly used bipolar treatment polytherapies. Polytherapy does not necessarily promote nonadherence. However, combination treatments may exacerbate medication adverse effects and/or create new adverse effects that would not occur with monotherapy.These issues need to be proactively addressed to optimize future symptom response and adherence outcomes.
Finally, given the frequency with which combination therapy is prescribed in clinical settings, there is a critical need for research that comprehensively evaluates outcomes in bipolar populations. As with bipolar mania and bipolar depression monotherapy trials, it is unlikely that atypicals are equivalent and indistinguishable. Differences between the various popular combinations should be explored using rigorous and systematic methods.
Dr Muzina is director of the Center for Mood Disorders Treatment and Research in the department of psychiatry at the Cleveland Clinic in Cleveland. Dr Sajatovic is professor of psychiatry at Case Western Reserve University School of Medicine in Cleveland and director of geropsychiatry at University Hospitals Case Medical Center in Cleveland. Dr Muzina reports that he is on the speakers’ bureau for AstraZeneca, Bristol-Myers Squibb, Pfizer, Sepracor, and Wyeth; and that he is a member of the scientific advisory board for AstraZeneca. Dr Sajatovic reports that she has received research funding from AstraZeneca, GlaxoSmithKline, and the NIMH; and she is a consultant for GlaxoSmithKline, Cognition Group, and AstraZeneca.
Drugs Mentioned in This Article
Aripiprazole (Abilify)
Carbamazepine (Carbatrol, Tegretol, others)
Clozapine (Clozaril)
Divalproex (Epival, Depakote)
Fluoxetine (Prozac, Sarafem)
Lamotrigine (Lamictal)
Lithium (Eskalith, Lithane, Lithobid)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Valproate/Valproic acid (Depakote, others)
Ziprasidone (Geodon)
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Evidence-Based References
Gianfrancesco FD, Rajagopalan K, Sajatovic M, Wang RH. Treatment adherence among patients with bipolar or manic disorder taking atypical and typical antipsychotics. J Clin Psychiatry. 2006;67:222-232.
Perlick DA, Rosenheck RA, Kaczynski R, Kozma L. Medication non-adherence in bipolar disorder: a patient-centered review of research findings. Clin Approaches Bipolar Disord. 2004;3:56-54.
