Medication for treatment resistance

What is treatment resistance in bipolar disorder?

Bipolar disorder is a persistent, episodic, and debilitating condition associated with recurring episodes of mania, hypomania, depression, and mixed manic-depressive states. These symptoms can lead to severe functional impairment, substance abuse, and suicidal behaviour. Treatment guidelines advocate the use of individual medications, with multiple medications indicated when a patient relapses on maintenance treatment. Unsatisfactory response to therapies is common in bipolar disorder, particularly during depressive episodes. Hence, there is a need to study medications that specifically target people with treatment resistance.

What is the evidence for medication for treatment resistance?

Moderate quality evidence finds the dopamine agonist pramipexole added to standard mood stabilisers can improve treatment-resistant bipolar depression. There may also be some improvement with the mood stabilisers modafinil or armodafinil. A single infusion of ketamine can improve depression one day after infusion, but is not sustained by two weeks after infusion.

Moderate to low quality evidence suggests clozapine and triiodothyronine may be effective for treatment-resistant bipolar disorder, including mania symptoms with clozapine, although the side effects of clozapine require careful monitoring.

November 2021

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Last updated at: 5:36 pm, 15th February 2022
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