Several treatment guidelines are available for clinicians working with patients with bipolar disorder (BD), but some of the more nuanced aspects of lithium therapy go beyond the scope of such guidelines. Therefore, in this perspective, our objective was to focus on specific practical issues of lithium treatment, including the selection and initiation of long-term treatment, and management and discontinuation (if indicated) of lithium prophylaxis.
Method:
We conducted a focused review of the relevant literature on the treatment of BD.
Results:
Consultation requests to a BD specialty service often relate to issues for which there is limited evidence, including when to initiate long-term treatment, whether choice of mood stabilizer is specific, how long to treat acute episodes, whether to switch or add on medication when treatment fails, how long to continue effective treatment, and what medication to use when a lithium-responsive patient must discontinue lithium.
Conclusion:
Optimal long-term treatment of BD will require more research as well as better alignment of clinical and training programs.
Méthode:
Nous avons mené une revue ciblée de la littérature pertinente sur le traitement du TB.
Résultats:
Les demandes de consultation à un service spécialisé en TB ont souvent trait aux questions pour lesquelles les données probantes sont limitées, notamment, le moment d'initier un traitement à long terme, si le choix d'un régulateur de l'humeur est spécifque, combien de temps traiter les épisodes aigus, s'il faut changer de médicament ou en ajouter lorsque le traitement échoue, combien de temps continuer un traitement efficace, et quel médicament utiliser quand un patient qui répond bien au lithium doit arrêter le lithium.
Conclusion:
Le traitement à long terme optimal du TB exigera plus de recherche ainsi qu'une meilleure harmonisation des programmes cliniques et de formation.
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