Several options exist, including clozapine.
Three recent articles discuss various adjunctive strategies available for the many patients with bipolar disorder (BD) that responds incompletely to mood stabilizers.
Rapid-cycling bipolar disorder (RCBD) may be more refractory to treatment than other bipolar types. In the open-label phase of a two-phase study, 133 depressed RCBD patients started on lithium plus divalproex. Only 14% stabilized; 10% withdrew due to adverse effects; 17% were nonadherent. In the double-blind phase, 49 nonresponders were randomized to placebo or lamotrigine. These two groups showed no difference in response rates.
To examine the possible efficacy of clozapine for refractory disease, investigators used a Danish database of 21,473 patients diagnosed with BD. Only 3…
Reviewing Author
DisclosuresRoyaltiesTextbook of Traumatic Brain Injury, 2nd and 3rd editions
Editorial BoardsUpToDate; Journal of Neuropsychiatry and Clinical Neuroscience
Leadership Positions in Professional SocietiesNorth American Brain Injury Association (Board Member); National Institute on Disability, Independent Living, and Rehabilitation Research (Chair of Data Monitoring Safety Board for study of donepezil on cognition after traumatic brain injury)
DisclosuresRoyaltiesTextbook of Traumatic Brain Injury, 2nd and 3rd editions
Editorial BoardsUpToDate; Journal of Neuropsychiatry and Clinical Neuroscience
Leadership Positions in Professional SocietiesNorth American Brain Injury Association (Board Member); National Institute on Disability, Independent Living, and Rehabilitation Research (Chair of Data Monitoring Safety Board for study of donepezil on cognition after traumatic brain injury)