The research and understanding of pharmacological treatments in bipolar disorder is rapidly changing. The American Psychiatric Association’s (APA) Treatment Guidelines for Bipolar Disorder, Second edition, published in 2002, are already substantially out of date as it applies to medications. For example, sweeping statements made about the benefits of the newer antipsychotic medications (atypicals) over the older ones (typicals) need to be revised in light of recent research that shows that the differences and advantages are not as great as previously thought.
At the same time, pharmaceutical companies have been actively seeking new indications (on-label uses) for the atypical antipsychotics and other medications. Since the publication of those guidelines, a number of medications have received FDA approval for use in the maintenance treatment of bipolar disorder as well as specific indications for either mania or depression.
The good news is that bipolar disorder is receiving significant attention, and with this burgeoning in research will hopefully come more effective treatments that can lessen the severity of mood episodes and improve overall functioning.
The challenge is that in research no one study is usually considered the be all and end all. Being able to replicate a study and get the same, or at least close to the same, findings is tremendously important, and it’s only after replicating a finding that one can have a degree of confidence in the results.
So with the excitement of all the new research, and new options, come a few cautionary words. With the exception of some important federally funded studies, most of the new research is underwritten by the pharmaceutical companies; these are for-profit corporations looking to bring new compounds to the market or find fresh indications for existing medications that will generate a profit.
So what we need to know about the advances in the field is: what are the latest studies showing, how strong are the results, and have those results been replicated in other studies by different researchers? It becomes a balance of keeping up to date and keeping in mind the medications that have been around for a longer time, that have an established track record and multiple studies to back up their usefulness.