Bipolar disorder is a devastating condition that affects approximately 3% of the population. Diagnosis of bipolar disorder is often confounded by the lack of insight patients have into their manic episodes; the end result is that many patients are not diagnosed until years after their first episode and receive no treatment or inappropriate treatment in the interim. Once the diagnosis is made, medication must be chosen that can control symptoms in the short term and prevent relapse in the long term. Medication tolerability affects treatment adherence and thus determines whether a medication will be effective, especially in the long-term maintenance phase of treatment. Thus, medication tolerability has important implications for the management of bipolar disorder because of the chronic nature of the disease and the need for long-term therapy.J Am
Psychiatr Nurses Assoc, 2007; 13(S5), S16-S22. DOI: 10.1177/1078390307305790
American Psychiatric Association (APA). (2000 ). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC : Author.
2.
American Psychiatric Association (APA). (2002 ). Practice guideline for the treatment of patients with bipolar disorder (revision). American Journal of Psychiatry, 159, 1-50.
3.
Angst, J., Angst, F., Gerber-Werder, R., & Gamma, A. (2005). Suicide in 406 mood-disorder patients with and without long-term medication: A 40 to 44 years' follow-up. Archives of Suicide Research, 9, 279-300.
4.
Angst, F., Stassen, H.H., Clayton, P.J., & Angst, J. (2002). Mortality of patients with mood disorders: Follow-up over 34-38 years. Journal of Affective Disorders, 68, 167-181.
5.
Bowden, C.L., Brugger, A.M., Swann, A.C., Calabrese, J.R., Janicak, P.G., Petty, F., et al. (1994). Efficacy of divalproex vs lithium and placebo in the treatment of mania. The Depakote Mania Study Group. Journal of theAmerican Medical Association, 271, 918-924.
6.
Bowden, C.L., Calabrese, J.R., Sachs, G., Yatham, L.N., Asghar, S.A., Hompland, M., et al. (2003). A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Archives of General Psychiatry,60, 392-400.
7.
Brown, E.B., McElroy, S.L., Keck, P.E. Jr., Deldar, A., Adams, D.H., Tohen, M., et al. (2006). A 7-week, randomized, double-blind trial of olanzapine/fluoxetine combination versus lamotrigine in the treatment of bipolar I depression. Journal of Clinical Psychiatry, 67(7), 1025-1033.
8.
Burdick, K.E., Endick, C.J., & Goldberg, J.F. (2005). Assessing cognitive deficits in bipolar disorder: Are self-reports valid? Psychiatry Research , 136, 43-50.
9.
Calabrese, J.R., Bowden, C.L., Sachs, G., Yatham, L.N., Behnke, K., Mehtonen, O.P., et al. (2003). A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. Journal ofClinical Psychiatry, 64, 1013-1024.
10.
Calabrese, J.R., Keck, P.E. Jr., Macfadden, W., Minkwitz, M., Ketter, T.A., Weisler, R.H., et al. (2005 ). A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression. American Journal of Psychiatry, 162, 1351-1360.
11.
Calabrese, J.R., Suppes, T., Bowden, C.L., Sachs, G.S., Swann, A.C., McElroy, S.L., et al. (2000). A double-blind, placebo-controlled, prophylaxis study of lamotrigine in rapid-cycling bipolar disorder. Journal ofClinical Psychiatry, 61, 841-850.
12.
Ghaemi, S.N., Boiman, E.E., & Goodwin, F.K. (2000). Diagnosing bipolar disorder and the effect of antidepressants: A naturalistic study. Journal ofClinical Psychiatry, 61, 804-808.
13.
Ghaemi, S.N., & Rosenquist, K.J. (2004). Is insight in mania state-dependent? A meta-analysis. Journal of Nervous and Mental Disease, 192, 771-775.
14.
Ghaemi, S.N., Rosenquist, K.J., Ko, J.Y., Baldassano, C.F., Kontos, N.J., & Baldessarini, R.J. (2004). Antidepressant treatment in bipolar versus unipolar depression. American Journal of Psychiatry,161, 163-165.
15.
Gonzalez, J.M., Thompson, P., Escamilla, M., Araga, M., Singh, V., Farrelly, N., et al. (2007). Treatment characteristics and illness burden among European Americans, African Americans, and Latinos in the first 2,000 patients of the systematic treatment enhancement program for bipolar disorder . Psychopharmacology Bulletin, 40(1), 31-46.
16.
Hirschfeld, R.M., Lewis, L., & Vornik, L.A. (2003). Perceptions and impact of bipolar disorder: How far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder. Journal of Clinical Psychiatry, 64, 161-174.
17.
Hirschfeld, R.M., & Vornik, L.A. (2005). Bipolar disorder—Costs and comorbidity. American Journal of Managed Care, 11, S85-S90.
18.
Judd, L.L., Akiskal, H.S., Schettler, P.J., Coryell, W., Endicott, J., Maser, J.D., et al. (2003). A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder . Archives of General Psychiatry,60, 261-269.
19.
Judd, L.L., Akiskal, H.S., Schettler, P.J., Endicott, J., Maser, J., Solomon, D.A., et al. (2002). The long-term natural history of the weekly symptomatic status of bipolar I disorder. Archives of General Psychiatry,59, 530-537.
20.
Keck, P.E., Calabrese, J.R., McQuade, R.D., Carson, W.H., Carlson, B.X., Rollin, L.M., et al. (2006). A randomized, double-blind, placebo-controlled 26-week trial of aripiprazole in recently manic patients with bipolar I disorder. Journal ofClinical Psychiatry, 67(4), 626-637.
21.
Ketter, T.A. (2005). Advances in the treatment of bipolar disorder . Washington, DC: American Psychiatric Publishing.
22.
Kogan, J.N., Otto, M.W., Bauer, M.S., Dennehy, E.B., Miklowitz, D.J., Zhang, H.W., et al. (2004). Demographic and diagnostic characteristics of the first 1000 patients enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Bipolar Disorders , 6(6), 460-469.
23.
Kravitz, H.M., & Fawcett, J. (1994). Efficacy of divalproex vs lithium and placebo in mania. Journal of theAmerican Medical Association, 272, 1005-1006.
24.
McIntyre, R.S., Brecher, M., Paulsson, B., Huizar, K., & Mullen, J. (2005). Quetiapine or haloperidol as monotherapy for bipolar mania—A 12-week, double-blind, randomised, parallel-group, placebo-controlled trial. European Neuropsychopharmacology, 15, 573-585.
25.
Meltzer, H.Y., Alphs, L., Green, A.I., Altamura, A.C., Anand, R., Bertoldi, A., et al. (2003). Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Archives of General Psychiatry, 60, 82-91.
26.
Nierenberg, A.A., Ostacher, M.J., Calabrese, J.R., Ketter, T.A., Marangell, L.B., Miklowitz, D.J., et al. (2006). Treatment-resistant bipolar depression: A STEP-BD equipoise randomized effectiveness trial of antidepressant augmentation with lamotrigine, inositol, or risperidone. American Journal of Psychiatry,163(2), 210-216.
27.
Perlis, R.H., Ostacher, M.J., Patel, J.K., Marangell, L.B., Zhang, H., Wisniewski, S.R., et al. (2006). Predictors of recurrence in bipolar disorder: Primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). American Journal of Psychiatry,163(2), 217-224.
28.
Sachs, G.S., Thase, M.E., Otto, M.W., Bauer, M., Miklowitz, D., Wisniewski S.R., et al. (2003). Rationale, design, and methods of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). BiologicalPsychiatry, 53, 1028-1042.
Smulevich, A.B., Khanna, S., Eerdekens, M., Karcher, K., Kramer, M., & Grossman, F. (2005). Acute and continuation risperidone monotherapy in bipolar mania: A 3-week placebo-controlled trial followed by a 9-week double- blind trial of risperidone and haloperidol. European Neuropsychopharmacology , 15, 75-84.
31.
Thase, M.E., Macfadden, W., Weisler, R.H., Chang, W., Paulsson, B., Khan A., et al. (2006). Efficacy of quetiapine monotherapy in bipolar I and II depression: A double-blind, placebo-controlled study (the BOLDER II study). Journal of Clinical Psychopharmacology, 26(6), 600-609.
32.
Tohen, M., Goldberg, J.F., Gonzalez-Pinto Arrillaga, A.M. , Azorin, J.M., Vieta, E., Hardy-Bayle, M.C., et al. (2003). A 12-week, double-blind comparison of olanzapine vs haloperidol in the treatment of acute mania. Archives of General Psychiatry, 60, 1218-1226.
33.
Tohen, M., Greil, W., Calabrese, J.R., Sachs, G.S., Yatham, L.N., Oerlinghausen, B.M., et al. (2005). Olanzapine versus lithium in the maintenance treatment of bipolar disorder: A 12-month, randomized, double-blind, controlled clinical trial. American Journal of Psychiatry,162, 1281-1290.
34.
Tohen, M., Vieta, E., Calabrese, J., Ketter, T.A., Sachs, G., Bowden, C., et al. (2003). Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Archives of General Psychiatry,60, 1079-1088.
35.
Tondo, L., Baldessarini, R.J., Hennen, J., Floris, G., Silvetti, F., & Tohen, M. (1998). Lithium treatment and risk of suicidal behavior in bipolar disorder patients. Journal ofClinical Psychiatry , 59, 405-414.
36.
Tondo, L., Isacsson, G., & Baldessarini, R.J. (2003). Suicidal behavior in bipolar disorder: Risk and prevention. CNSDrugs, 17, 491-511.
37.
Vieta, E., Bourin, M., Sanchez, R., Marcus, R., Stock, E., McQuade, R., et al. (2005). Effectiveness of aripiprazole v. haloperidol in acute bipolar mania: Double-blind, randomised, comparative 12-week trial . British Journal of Psychiatry, 187, 235-242.
