Pharmacological management of bipolar disorder: Japanese expert consensus

Hitoshi Sakurai, Masaki Kato, Norio Yasui-Furukori, Takefumi Suzuki, Hajime Baba, Koichiro Watanabe, Ken Inada, Ikuko Kishida, Yuka Sugawara Kikuchi, Toshiaki Kikuchi, Asuka Katsuki, Hiroyuki Uchida

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: The aim of this study was to develop a consensus guideline by certified experts of the Japanese Society of Clinical Neuropsychopharmacology on the psychopharmacological treatment for bipolar disorders I and II (BP-I and BP-II), in order to fill the gap in the literature and provide more concrete guidance for challenging and controversial real-world situations. Methods: Experts were asked to assess treatment options regarding 19 clinical situations of bipolar disorder with a nine-point Likert scale (one = “disagree” and nine = “agree”). According to the responses from 119 experts, the options were categorized into the first-, second-, and third-line treatments. Results: For the treatment of BP-I, lithium monotherapy was categorized as a first-line treatment for manic episodes (mean ± standard deviation score, 7.0 ± 2.2), depressive episodes (7.1 ± 2.0), and the maintenance phase (7.8 ± 1.8). Combination therapy of lithium and an atypical antipsychotic was endorsed for manic episodes (7.7 ± 1.7), depressive episodes with (7.1 ± 2.0) and without mixed features (6.9 ± 2.2), and the maintenance phase (6.9 ± 2.1). Similarly, in BP-II, lithium monotherapy was categorized as a first-line treatment for hypomanic episodes (7.3 ± 2.2), depressive episodes (7.0 ± 2.2), and the maintenance phase (7.3 ± 2.3), while combination therapy of lithium and an atypical antipsychotic was recommended for hypomanic episodes (6.9 ± 2.4).No antipsychotic monotherapy or antidepressant treatment was categorized as a first-line treatment for any type of episode. Conclusions: These recommendations reflect the current evidence and represent the experts' consensus on using lithium for the treatment of bipolar disorder. Clinicians should consider the effectiveness and adverse effects of antipsychotic and antidepressant medications for the treatment of bipolar disorder.

Original languageEnglish
JournalBipolar Disorders
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • bipolar disorder
  • expert consensus guideline
  • lithium
  • pharmacotherapy
  • treatment guideline

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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    Sakurai, H., Kato, M., Yasui-Furukori, N., Suzuki, T., Baba, H., Watanabe, K., Inada, K., Kishida, I., Sugawara Kikuchi, Y., Kikuchi, T., Katsuki, A., & Uchida, H. (Accepted/In press). Pharmacological management of bipolar disorder: Japanese expert consensus. Bipolar Disorders. https://doi.org/10.1111/bdi.12959