Landmark Review Reveals The Most Effective Bipolar Disorder Treatments

The highs and lows of bipolar disorder are difficult enough – and then there's the chaos of finding treatments that actually help through the peaks, troughs, and everywhere in between.

One of the most substantial reviews of bipolar disorder treatments across different mood phases has just been published in The BMJ, along with a web-based tool to help doctors and patients find which approach might work best for them.

"Nearly half of individuals with bipolar disorder do not adhere to prescribed treatments, often because of perceived inefficacy, poor tolerability, or insufficient involvement in decision-making," the paper's authors write.

Medical knowledge changes at least a little bit every time more research comes out, but due to time constraints, doctors and patients can struggle to keep up.

But adherence to medication and other treatments can be life-or-death for people living with bipolar.

"Research on bipolar disorder treatment moves so quickly that it's nearly impossible to keep up," says clinical investigator and psychiatrist Marco Solmi, who works at The Ottawa Hospital and the University of Ottawa's mental health department.

The tool compiles the results of 77 existing meta-analyses (in which scientists gather the results of multiple studies together to see broader trends), grading bipolar treatments based on the certainty of the scientific evidence, as well as their efficacy (in terms of symptoms, response, and remission) across different phases of the disorder.

"We hope clinicians will be able to use the platform with their own patients to find the best balance between efficacy and side effects, according to each patient's needs," says Michele De Prisco, psychiatrist and researcher at the Hospital Clínic de Barcelona and the University of Barcelona.

"Using the platform and its integrated preference tool, clinician and patient can decide together which treatment to consider next."

Here's a snapshot of what the review found, bearing in mind that the whole point of this resource is to give real-time updates as the research moves forward.

Also bear in mind that we at ScienceAlert are not doctors. Before you make any changes to your health care routines, book an appointment with a qualified doctor to talk it over.

During depressive phases of the disorder in adults, cariprazine, lurasidone, olanzapine, and quetiapine stood out for their performance and at least moderate-to-high scientific certainty across all three efficacy outcomes. That means there's good evidence that they work well.

For manic phases, the review found haloperidol and risperidone had the greatest effects on symptoms and response, with high certainty in both measures (again, good evidence that they work well).

Risperidone has the added benefit of a long-acting, injectable form, which can also help patients through the in-betweens (or 'maintenance phase') of their bipolar symptoms.

It's also worth noting that tamoxifen stood out for mania, with an effect size far beyond the other drug treatments. But there's a catch.

This drug is actually not even approved for bipolar disorder treatment yet: it's a hormone therapy used mainly as a breast cancer drug.

Early trials have shown a lot of promise with tamoxifen, but there's really not enough to go off yet – and as a hormone therapy, it's not going to be right for every patient. Further research into this one is definitely needed.

When it comes to the maintenance phase of bipolar, and especially treatments that could help prevent acute phases or 'episodes', a non-drug approach came to the fore, hitting all three efficacy outcomes with at least moderate scientific certainty: group psychoeducation.

"The only intervention supported by at least moderate certainty for the prevention of any episode, including depressive and manic episodes (although with only a small effect)… was group psychoeducation added to usual care pharmacological interventions," the authors report.

They suggest it might work by improving patients' perceptions of their illness, potentially leading to improved lifestyle choices, circadian rhythms, and adherence to pharmacological treatments.

Cognitive behavioral therapy also showed evidence of improving symptoms and preventing mood episode relapses.

But as we've already noted, all of these results are fixed in time, and don't factor in patient preference.

Meta-meta-analyses can only reveal what works best at a population level.

They can't tell us what will necessarily work best in your body, let alone how these treatments interact with all the other things you've got going on in your life.

Related: Bipolar Disorder Linked to a Higher Risk of Early Death Than Smoking

The real work of treating bipolar happens between doctor and patient, to meet their needs on a case-by-case basis.

The long-term idea for the online tool is to continuously add new research results as they are released, so clinicians can factor in population-level data into their search to find the best treatment for each patient's personal situation.

"This living review is a foundation for continuously improving clinical care in bipolar disorder, being rapidly adaptable as new evidence emerges," the authors conclude.

Next, they need to find out how well their tool actually works in real-world settings.

The research was published in The BMJ.

If this story has raised concerns or you need to talk to someone, please consult this list to find a 24/7 crisis hotline in your country, and reach out for help.