Intended for healthcare professionals

Rapid response to:

Clinical Review

Bipolar disorder

BMJ 2012; 345 doi: (Published 27 December 2012) Cite this as: BMJ 2012;345:e8508

Rapid Response:

Re: Bipolar disorder

This is a very comprehensive review of all the stages of bipolar disorder, including all the recent significant literature. A trial of typical antipsychotics is worth considering for Bipolar. In third world countries, where cost of medication is big issue, economical and safe alternatives are a huge relief for carers and patients.

I think that the literature search was vigorous but could have searched other search engines like Psycinfo to gather more evidence. A criterion for selection of high quality studies needs more elaboration. Studies like STEP-BD need a special place specifically when one thinks of predictors of relapse and their importance in the management of illness. Scientific evidence is reporting Quetiapine as an emerging medicine for treatment of bipolar disorder, specifically for the depressive phase, but a lot more time is needed to win the confidence of doctors. To consider efficacy of haloperidol superior to lithium is a bit premature; more high quality data are needed.

Treatment in difficult settings and issues like pregnancy and breast feeding in bipolar disorder have no single answer. From mood stabilizers to atypical antipsychotics like olanzapine, each has its own benefits and perks. Typical antipsychotics advocated in pregnant women in schizophrenia might find a role in bipolar effective disorder as well. A criterion specifically for bipolar disorder in children and adolescents has been criticized, and hopefully has a stringent criterion to prevent over diagnosis in DSM-5, which is expected to be released in May 2013.


Perlis RH, Ostacher MJ, et al. Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Focus. 2006;4(4):553.

Competing interests: No competing interests

06 January 2013
Department of Psychiatrist
Aga Khan University Hospital, Karachi