An intensive two-year-long early intervention for first episode psychosis showed early promise relative to standard care, yielding superior improvement in both positive and negative symptoms, as well as lower rates of substance abuse and lower antipsychotic medication doses.
Much of what is confusing and controversial in the treatment of bipolar disorder revolves around the role of antidepressants. Are they dangerous or safe? Are they effective or ineffective? Does it matter whether the patient has Bipolar I or II?
Lamictal (lamotrigine) is immensely popular among American psychiatrists. A recent survey found that it is prescribed more frequently than any other mood stabilizer (Clin Psychiatry News, June 2008, page 1).
While we have become sensitized to worrying about weight gain caused by antipsychotics, this side effect does occur with standard mood stabilizers as well. Recently, a comprehensive literature review was published evaluating the weight gain liabilities of medications commonly used to treat bipolar disorder (Torrent et al., Acta Psychiatrica Scand 2008;118:4-18). Here is what they found.
Dr. Phelps, before we begin, I know that you have always been very up front about the fact that you speak for drug companies, and I wonder how you think this might influence what you have to say about the diagnosis of bipolar disorder?
Dr. Zimmerman, you recently published a paper in which you suggested that bipolar disorder is overdiagnosed in some populations. Can you describe that research?
Last year, we reviewed a meta-analysis implying that bupropion is as effective as SSRIs for the treatment of patients with mixed anxiety and depression (TCPR, Aug 2007). In a new paper, these same researchers have sliced and diced the data a bit differently in order to answer this topic more confidently.
Cognitive behavior therapy (CBT) is widely acknowledged to be the most well-researched, and possibly the most effective therapy option for a wide variety of disorders. The problem is that it is not widely available, particularly in the treatment of patients with substance abuse disorders.
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