Making Optimal Use of Combination Pharmacotherapy in Bipolar Disorder
Charles L. Bowden, MD
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Because patients with bipolar disorder often do not respond sufficiently to treatment with 1 mood
stabilizer, psychiatrists frequently employ combination therapy and add antipsychotics, antiepileptics,
or antidepressants to mood stabilizers. Combination therapy can be more effective than monotherapy
in controlling breakthrough or treatment-resistant episodes. For example, atypical antipsychotics have
been shown to be effective adjunctive treatments for mania and for patients with psychotic symptoms
during a depressive episode, while the combination of a mood stabilizer and lamotrigine or an antidepressant
has been found to control bipolar depression. The American Psychiatric Association guideline
for the treatment of bipolar disorder recommends optimizing individual medications before
switching to combination therapy. Selecting a combination treatment regimen with an acceptable side
effect profile is critically important because patients may discontinue therapy they cannot tolerate.
Agents should be added carefully, with continued monitoring of adverse effects. Physicians should
give patients only as much medication as needed.
J Clin Psychiatry 2004;65(suppl 15):21-24
© Copyright 2004 Physicians Postgraduate Press, Inc.
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