Bipolar disorder is a serious mental health-care concern as it severely reduces patients’ quality of life and functioning.[1] Bipolar disorder is characterised by extremes of mood or ‘poles’ – mania and depression. Some patients experience mixed states of both mania and depression and some experience rapid cycling when four or more episodes of mania or depression occur within a year. Bipolar I disorder is characterised by a cycling disease course – the patient experiences alternating cycles of mania and depression, usually with intervening periods of normal mood. Bipolar II disorder is characterised by full depressive episodes, with intervening bouts of hypomania. On average, patients with bipolar disorder spend three times more days depressed than manic or hypomanic over a year.[2]
The prevalence rate of bipolar disorder in Europe is estimated to be approximately 1%.[3] The economic burden of bipolar disorder is high, with hospitalisation accounting for a large proportion of costs.[3]
Two major factors may hinder the diagnosis of bipolar disorder: the overlap of the symptoms of bipolar disorder with those of other psychiatric disorders and the presence of comorbid conditions. In fact, misdiagnosis is common, with around 80% of patients with bipolar disorder receiving an incorrect diagnosis, 31% being diagnosed incorrectly with unipolar depression.[4]
The main treatment goal for bipolar disorder is to stabilise mood. Treatment adherence is a significant concern in the management of patients with this condition as around 40% of patients with bipolar disorder are partially or totally nonadherent to treatment.[5]
Bipolar mania
Typical symptoms of bipolar mania include grandiosity, recklessness, euphoria and pressured speech.
Recent guidelines from the Canadian Network for Mood and Anxiety Treatments (CANMAT) recommend lithium, divalproex and the atypical antipsychotics aripiprazole, olanzapine, risperidone, SEROQUEL, SEROQUEL XR and ziprasidone as first-line treatments for acute bipolar mania.[6]
More information on the use of SEROQUEL XR in bipolar mania treatment can be obtained from the Bipolar Mania Treatment page.
Bipolar depression
Bipolar depression occurs in approximately 29.5 million people Worldwide[7] and accounts for 2% of disability-adjusted life years for non-communicable diseases Worldwide in 2005.[8] Typical bipolar depression symptoms include sadness, loss of interest, hopelessness, anxiety and a negative mood causing irritability, hostility, and violence.
The aim of treatment is to reduce the symptoms of bipolar depression and stabilise mood. Guidelines on the treatment of bipolar depression typically recommend lamotrigine or quetiapine (SEROQUEL XR and SEROQUEL) monotherapy as first-line treatment options for patients with bipolar I depression.[6],[9] In addition, lithium monotherapy, lithium/divalproex, lithium/divalproex plus a selective serotonin reuptake inhibitor or lithium/divalproex plus bupropion are recommended in this setting.[6] For the treatment of acute bipolar II depression, CANMAT guidelines recommend SEROQUEL XR and SEROQUEL as a first-line treatment, with second-line options of lithium, lamotrigine, divalproex, lithium/divalproex, lithium/divalproex plus an antidepressant, atypical antipsychotic plus antidepressant.[6]
For more information on SEROQUEL XR and it’s efficacy in the treatment of bipolar depression, please see the Seroquel XR: Bipolar Depression page.
References
- Malhi et al. Drugs 2009; 69: 2063-2101
- Kupka et al.Bipolar Disord 2007; 9: 531-535.
- Fajutrao et al. Clin Pract Epidemol Ment Health 2009; 5: 3.
- Hirschfeld et al. J Clin Psychiatry 2003; 64: 53-59.
- Montoya et al. Actas Esp Psiquiatr 2007; 35: 315-322.
- Yatham et al. Bipolar Disord 2009; 11: 225-255.
- World Health Organization. The global burden of disease 2004 update. 2008.
- Prince et al. Lancet 2007; 370: 859-877.
- Goodwin GM. J Psychopharmacol 2009; 23: 346-388.