Open AccessRefractoriness in Bipolar Disorder: Definitions and Evidence‐Based Treatment
Author(s) -
Fountoulakis Konstantinos N.
Publication year - 2012
Publication title -
cns neuroscience and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 69
eISSN - 1755-5949
pISSN - 1755-5930
DOI - 10.1111/j.1755-5949.2011.00259.x
Subject(s) - quetiapine , oxcarbazepine , bipolar disorder , aripiprazole , refractory (planetary science) , risperidone , olanzapine , carbamazepine , refractory period , lithium (medication) , lamotrigine , medicine , treatment of bipolar disorder , psychology , psychiatry , schizophrenia (object oriented programming) , mania , epilepsy , physics , astrobiology
SUMMARY Defining refractoriness in bipolar disorder is complex and should concern and include either every phase and pole or the disorder as a whole. The data on the treatment of refractory bipolar patients are sparse. Combination and add‐on studies suggest that in acutely manic patients partial responders to lithium, valproate, or carbamazepine, a good strategy would be to add haloperidol, risperidone, olanzapine, quetiapine, or aripiprazole. Adding oxcarbazepine to lithium is also a choice. There are no reliable data concerning the treatment of refractory bipolar depressives and also there is no compelling data for the maintenance treatment of refractory patients. It seems that patients stabilized on combination treatment might do worse if shifted from combination. Conclusively there are only limited and sometimes confusing data on the treatment of refractory bipolar patients. Further focused research is necessary on this group of patients.