Editorials

Treatment of bipolar affective disorder

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7272.1302 (Published 25 November 2000) Cite this as: BMJ 2000;321:1302

New drug treatments are emerging, but more clinical evidence is required

  1. A H Young, professor of psychiatry,
  2. Karine A N Macritchie, specialist registrar,
  3. J R Calabrese, director, mood disorders programme
  1. Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  2. Case Western Reserve University School of Medicine, 11400 Euclid Ave, Suite 200, Cleveland, Ohio 44106, USA

    Bipolar affective disorder is a common condition which, among mental illnesses, ranks second only to unipolar depression as a cause of worldwide disability.1 Classically, it manifests itself as repeated periods of illness with complete recovery. However, many patients have a poor outcome: a third suffer chronic symptoms and some 13-24% develop rapid cycling disorder, where four or more episodes occur within a year. The lifetime risk of bipolar disorder is at least 1.2%, with a recognised risk of completed suicide of 15%. Young men, early in the course of their illness, are at highest risk, especially those with a history of suicide attempts or alcohol abuse and those recently discharged from hospital. Despite its shortcomings, lithium has long been the mainstay of treatment for bipolar affective disorder. Several newer drugs have emerged over the past 10 years, but evidence of their effectiveness remains disappointingly thin.

    Ideally, mood stabilisers should treat both mania and depression and prevent their recurrence. Importantly, treatment itself should not precipitate mania or depression or induce rapid cycling. Lithium has been used as a mood …

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