Bipolar retrospective: highlighting key work in bipolar research

As part of World Bipolar Day, the editors of International Journal of Bipolar Disorders go back through the articles published in the journal. They pick out work of special significance, and explain exactly why these are so important.

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admin-ajaxMichael Bauer and Michael Berk work on International Journal of Bipolar Disorders, and are known around the world as two of the leading figures in the field, with more than 50 years experience working with bipolar disorders between them. We asked them. To help raise awareness of the most important issues in bipolar research, they pick out their favourite articles in International Journal of Bipolar Disorders, and explain why these are worth of special attention.

Michael Bauer (Editor-in-Chief)

Lithium for prevention of mood episodes in bipolar disorders: systematic review and meta-analysis

Severus et al. 2014

Pharmacological treatment with mood stabilizers is essential for the long-term (relapse-preventive) treatment of bipolar disorder. More than 66 years from the breakthrough of identifying lithium salts to have antimanic and prophylactic activity, modern research serves to further substantiate lithium’s position at the front-line in the treatment of bipolar disorder. Undoubtedly, lithium is an essential medication for patients with mood disorders and represents the most valuable treatment option in the long-term treatment of bipolar disorders. When used correctly, lithium unquestionably produces the most dramatic benefits of any medication in psychopharmacology.

Despite of this and the fact that lithium is consistently ranked as first choice for the long-term treatment of bipolar disorders in international treatment guidelines lithium is dramatically underutilized in clinical practice in many countries. This meta-analysis of 7 randomized, placebo-controlled long-term studies from Severus et al. confirmed its profound efficacy regarding the prevention of overall mood episodes, manic episodes, depressive episodes (dependent on the type of analyses performed) and acceptability (completion of study). With this scientific milestone to demonstrate the evidence base for lithium in the long-term, prophylactic treatment of bipolar disorders has strengthened. With no other drug available having such ample and consistent evidence for its efficacy lithium remains the most valuable treatment option in this indication.

The role of childhood trauma in bipolar disorders

Aas et al. 2016

Childhood physical abuse is associated with an increased risk for the development of substance dependency, psychotic disorders, depression and anxiety disorders. Due to more recent research in this area, there is increasing evidence that childhood trauma represent a risk factor for bipolar disorder. For example, a case-control study assessing more than 200 bipolar patients showed that multiple traumas (e.g. emotional and sexual abuse, emotional neglect) are more frequent in patients with bipolar disorder than in healthy controls. The main clinical implication is to systematically assess childhood trauma in patients with bipolar disorders, particularly in those with an instable course. The review by Aas et al. presents a comprehensive overview on the role of childhood trauma in the etiology and course of bipolar disorder, a widely neglected research area. One of the challenges is to fill the gap between clinical research and routine practice, since recommendations for managing this specific population are lacking.

Online information seeking by patients with bipolar disorder: results from an international multisite survey

Conell et al. 2016

Despite a growing number of mental health web sites, there is little understanding of how patients with bipolar disorder use the Internet to seek information. There is considerable international interest in online education of patients with bipolar disorder, yet little understanding of how patients use the Internet and other sources to seek information.  In this study, patients with bipolar disorder diagnosis in 17 countries completed a paper-based, anonymous survey. A 39 question, paper-based, anonymous survey, translated into 12 languages, was completed by 1222 patients in 17 countries.  976 (81%) of the patients used the Internet, and of these 750 (77%) looked for information on bipolar disorder. The results of this survey clearly indicated that online information seeking helps many patients to cope, although alternative information sources remain important.  Most patients do not discuss Internet findings with their doctor, and concern remains about the quality of online information especially related to prescription drugs. More patient education about online information searching is needed and physicians should recommend a few high quality web sites.

Michael Berk (Associate Editor)

Lithium side effects and toxicity: prevalence and management strategies

Gitlin 2016

This paper is to be welcomed, as a number of recent publications have emphasized the primacy of lithium in terms of efficacy. Despite this prescription rates are declining and many newer generation clinicians prefer alternatives with poorer efficacy. While this in part is driven by active marketing on the side of industry, fear of side effects is an important driver of declining use of lithium.

If the patient population is to derive optimal benefit from available therapies them lithium needs to be used more widely. This important paper provides guidelines and strategies for clinicians to safely manage the long term use of lithium. It’s synthesizes the extent literature and has extensive clinical wisdom. As such it has the capacity to improve patient care and deserves to be widely read.

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Marylou Selo

Yesterday was World Bipolar Day. Why March 30th? It is the birthday of Vincent van Gogh. We bipolar patients are always proud to have a brilliant example of a fellow-patient blessed with a ton of creativity. Van Gogh struggled valiantly with his illness without the benefits of Lithium or any other modern medication. Possibly he sought relief by self-medicating with light therapy by moving to France, where the light is so much brighter than in Belgium or The Netherlands.
Perhaps the bipolar patient population as a whole would benefit from research on light therapy in conjunction with Lithium to keep patients stable and creative during winter. Marylou Selo, 2016-awardee of the Mogens Schou Award for Public Advocacy.

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