Subscribe to RSS
DOI: 10.1055/s-2005-867026
Rezidivprophylaxe bipolarer Erkrankungen
Prophylaxis of Bipolar DisorderPublication History
Publication Date:
01 March 2006 (online)
![](https://www.thieme-connect.de/media/psychiat-praxis/2006S1/lookinside/thumbnails/10.1055-s-2005-867026-1.jpg)
Zusammenfassung
Bis vor einigen Jahren hat sich die medikamentöse Behandlung zur Verhinderung von Rückfällen bei bipolaren Erkrankungen in erster Linie auf Lithium beschränkt, das sich vor allem bei den typischen, klassischen Verläufen der bipolaren Störungen mit seiner stimmungsstabilisierenden Wirkung und antisuizidalem Effekt günstig auf den Krankheitsverlauf auswirkt. Bei atypischen Symptomen oder schnellem Phasenwechsel jedoch scheint die Effektivität eingeschränkt, mit der Konsequenz, dass weitere Therapieoptionen, v. a. Antiepileptika wie Carbamazepin, Valproat oder Lamotrigin auch in der Indikation der prophylaktischen Anwendung untersucht wurden. Auch atypische Neuroleptika, Schilddrüsenhormone und Omega-Fettsäuren wurden in Langzeitstudien bezüglich stimmungsstabilisierender Effekte untersucht. Der vorliegende Artikel fasst den gegenwärtigen Stand zur Wirksamkeit der verschiedenen Therapieoptionen in der Langzeittherapie zusammen.
Abstract
Until recently, the psychopharmacological treatment alternatives for bipolar maintenance treatment were limited to lithium, which seems of special usefulness in a classical manifestation of the illness with mood-stabilising and anti-suicidal properties. With atypical features like psychotic symptoms or rapid cycling, lithium seems to be less useful. This led to further research into alternative options as carbamazepine, valproate or lamotrigine as well as atypical neuroleptics, thyroid hormones or innovative substances like omega fatty acids. This article summarises the current state of knowledge on treatment options for maintenance therapy.
Literatur
- 1 American Psychiatric Association . Practice guideline for the treatment of patients with bipolar disorder. American Psychiatric Association. Am J Psychiatry. 1994; 151 (12 Suppl) 1-36
- 2 Bourgeois M L, Hantouche E G, Akiskal H S. The Epiman and Epidep french studies of bipolarity. Journal of Bipolar Disorder. 1997; 1 (1) 13-19
- 3 Angst J. Epidemiologie du spectre bipolaire. Encephale. 1995; 21 37-42
- 4 Baastrup P C, Schou M. Lithium as a prophylactic agents. Its effect against recurrent depressions and manic-depressive psychosis. Arch Gen Psychiatry. 1967; 16 (2) 162-172
- 5 Walden J, Grunze H. Bipolare affektive Störungen - Ursachen und Behandlung. 3 ed. Stuttgart, New York; Thieme 2003
- 6 Bowden C L. Efficacy of lithium in mania and maintenance therapy of bipolar disorder. J Clin Psychiatry. 2000; 61, Suppl 9 35-40
- 7 Calabrese J R, Fatemi S H, Kujawa M, Woyshville M J. Predictors of response to mood stabilizers. J Clin Psychopharmacol. 1996; 16 (2, Suppl 1) 24-31
- 8 Calabrese J R, Shelton M D, Rapport D J, Youngstrom E A, Shirley E, Elhaj O. et al . A 20-month, double-blind, maintenance study of lithium versus divalproex monotherapy in bipolar I and II disorder accompanied by rapid cycling. Eur Neuropsychopharmacol. 2003; 23, Suppl 4 227
- 9 Greil W, Ludwig-Mayerhofer W, Erazo N, Schöchlin C, Schmidt S, Engel R R. et al . Lithium versus carbamazepine in the maintenance treatment of bipolar disorders - a randomised study. J Affect Disord. 1997; 43 (2) 151-161
- 10 Hartong E G, Moleman P, Hoogduin C A, Broekman T G, Nolen W A. Prophylactic efficacy of lithium versus carbamazepine in treatment-naive bipolar patients. J Clin Psychiatry. 2003; 64 (2) 144-151
- 11 Bowden C L, Calabrese J R, McElroy S L, Gyulai L, Wassef A, Petty F. et al . A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintenance Study Group. Arch Gen Psychiatry. 2000; 57 481-489
- 12 Bowden C L, Calabrese J R, Sachs G, Yatham L N, Asghar S A, Hompland M. et al . A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry. 2003; 60 (4) 392-400
- 13 Calabrese J, Bowden C L, Sachs G, Yatham L N, Behnke K, Mehtonen O-P. et al . A Placebo-Controlled 18-Month Trial of Lamotrigine and Lithium Maintenance Treatment in Recently Depressed Patients with Bipolar I Disorder. J Clin Psychiatry. 2003; 64 (1013) 1024
- 14 Calabrese J R, Suppes T, Bowden C L, Sachs G S, Swann A C, McElroy S L. et al . A double-blind, placebo-controlled, prophylaxis study of lamotrigine in rapid-cycling bipolar disorder. Lamictal 614 Study Group. J Clin Psychiatry. 2000; 61 (11) 841-850
- 15 Suppes T, Webb A, Paul B, Carmody T, Kraemer H, Rush A J. Clinical outcome in a randomized 1-year trial of clozapine versus treatment as usual for patients with treatment-resistant illness and a history of mania. Am J Psychiatry. 1999; 156 (8) 1164-1169
- 16 Vieta E, Goikolea J M, Corbella B, Benabarre A, Reinares M, Martinez G. et al . Risperidone safety and efficacy in the treatment of bipolar and schizoaffective disorders: results from a 6-month, multicenter, open study. J Clin Psychiatry. 2001; 62 (10) 818-825
- 17 Tohen M, Ketter T A, Zarate C A, Suppes T, Frye M, Altshuler L. et al . Olanzapine versus divalproex sodium for the treatment of acute mania and maintenance of remission: a 47-week study. Am J Psychiatry. 2003; 160 (7) 1263-1271
- 18 Tohen M, Chengappa K N, Suppes T, Baker R W, Zarate C A, Bowden C L. et al . Relapse prevention in bipolar I disorder: 18-month comparison of olanzapine plus mood stabiliser v. mood stabiliser alone. Br J Psychiatry. 2004; 184 337-345
- 19 Tohen M, Marneros A, Greil W, Koukopoulos A, Calabrese J R, Bowden C. et al .Olanzapine versus Lithium in Relapse/Recurrence Prevention in Bipolar Disorder: A Randomized Double-blind Controlled 12-month Clinical Trial. Am J Psychiatry in press
- 20 Tohen M, Bowden C, Calabrese J, Chou J C, Baker R W, Williamson D. et al . Olanzapine's efficacy for relapse prevention in bipolar disorder: A randomized double-blind controlled 12-month clinical trial. World J Biol Psychiatry. 2004; 5, suppl 1 51
- 21 Bauer M, Hellweg R, Baumgartner A. Hochdosierte Thyroxinbehandlung bei therapie- und prophylaxeresistenten Patienten mit affektiven Psychosen. Nervenarzt. 1998; 69 (11) 1019-1022
- 22 Stoll A L, Severus W E, Freeman M P, Rueter S, Zboyan H A, Diamond E. et al . Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Arch Gen Psychiatry. 1999; 56 (5) 407-412
- 23 Keck P, Mintz J, McElroy S, Freeman M P, Suppes T, Frye M. et al .Double-Blind, Randomized, Placebo-Controlled Trials of Ethyl-Eicosapentanoate in the Treatment of Bipolar Depression and Rapid Cycling Bipolar Disorder. Am J Psychiatry in press
- 24 Grunze H, Walden J, Dittmann S, Berger M, Bergmann A, Bräunig P. et al . Psychopharmakotherapie Bipolarer Affektiver Erkrankungen. Nervenarzt. 2002; 73 4-17
- 25 Johnson R E, McFarland B H. Lithium use and discontinuation in a health maintenance organization. Am J Psychiatry. 1996; 153 (8) 993-1000
- 26 Scott J, Pope M. Self-reported adherence to treatment with mood stabilizers, plasma levels, and psychiatric hospitalization. Am J Psychiatry. 2002; 159 (11) 1927-1929
- 27 Miklowitz D J, Frank E, George E L. New psychosocial treatments for the outpatient management of bipolar disorder. Psychopharmacol Bull. 1996; 32 (4) 613-621
- 28 Swartz H A, Frank E. Psychotherapy for bipolar depression: a phase-specific treatment strategy?. Bipolar Disord. 2001; 3 (1) 11-22
- 29 Colom F, Vieta E, Martinez-Aran A, Reinares M, Goikolea J M, Benabarre A. et al . A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry. 2003; 60 (4) 402-407
- 30 Keller M B, Lavori P W, Coryell W, Endicott J, Mueller T I. Bipolar I: a five-year prospective follow-up. J Nerv Ment Dis. 1993; 181 (4) 238-245
- 31 Goodwin F K, Ghaemi S N. Understanding manic-depressive illness. Arch Gen Psychiatry. 1998; 55 (1) 23-25
- 32 Möller H-J, Grunze H. Do recent efficacy data on the drug treatment of acute bipolar depression support the position that drugs other than antidepressants are the treatment of choice? A conceptual review. Eur Arch Psychiatry Clin Neurosci in press
- 33 Altshuler L, Suppes T, Black D, Nolen W A, Keck Jr P E, Frye M A. et al . Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up. Am J Psychiatry. 2003; 160 (7) 1252-1262
- 34 Sachs G S, Printz D J, Kahn D A, Carpenter D, Docherty J P. The Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder 2000. Postgrad Med Spec Report. 2000; 1-104
- 35 Nolen W A, Knoppert-van der Klein E AM, Bouvy P F, Honig A, Klompenhouwer J L, Wit A De. et al .Richtlijn bipolaire stoornissen. Amsterdam; Boom 2001
- 36 Grunze H, Kasper S, Goodwin G, Bowden C L, Möller H-J. WFSBP Task Force on Treatment Guidelines for Bipolar Disorders . The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders. Part III: Maintenance treatment. World J Biol Psychiatry. 2004; 5 120-135
- 37 Prien R F, Caffey E M. Lithium prophylaxis: a critical review. Compr Psychiatry. 1974; 15 (5) 257-263
- 38 Bowden C L, Lecrubier Y, Bauer M, Goodwin G, Greil W, Sachs G. et al . Maintenance therapies for classic and other forms of bipolar disorder. J Affect Disord. 2000; 59, Suppl 1 57-67
- 39 Bowden C L, Singh V. Valproate in bipolar disorder: 2000 onwards. Acta Psychiatr Scand Suppl. 2005; (426) 13-20
- 40 Gelenberg A J, Kane J M, Keller M B, Lavori P, Rosenbaum J F, Cole K. et al . Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorder. N Engl J Med. 1989; 321 (22) 1489-1493
- 41 Kleindienst N, Greil W. Lithium in the long-term treatment of bipolar disorders. Eur Arch Psychiatry Clin Neurosci. 2003; 253 (3) 120-125
- 42 VanValkenburg C, Kluznik J, Merrill R, Erickson W. Therapeutic levels of valproate for psychosis. Psychopharmacol Bull. 1990; 26 (2) 254-255
- 43 Bowden C L, Janicak P G, Orsulak P, Swann A C, Davis J M, Calabrese J R. et al . Relation of serum valproate concentration to response in mania. Am J Psychiatry. 1996; 153 (6) 765-770
- 44 Geddes J R, Burgess S, Hawton K, Jamison K, Goodwin G M. Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry. 2004; 161 (2) 217-222
- 45 Maj M, Pirozzi R, Magliano L, Bartoli L. Long-term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic. Am J Psychiatry. 1998; 155 (1) 30-35
- 46 Gitlin M J, Swendsen J, Heller T L, Hammen C. Relapse and impairment in bipolar disorder. Am J Psychiatry. 1995; 152 (11) 1635-1640
-
47 Greil W, Kleindienst N, Schlösser S.
Medikamentöse Rezidivprohylaxe affektiver Störungen. In: Möller H-J (Hrsg) Therapie psychiatrischer Erkrankungen. Stuttgart; Enke 1999: 424-450 - 48 Goodwin F K, Jamison K R. Manic-depressive illness. New York; Oxford University Press 1990
- 49 Dunner D L, Fieve R R. Clinical factors in lithium carbonate prophylaxis failure. Arch Gen Psychiatry. 1974; 30 (2) 229-233
- 50 Calabrese J R, Rapport D J, Youngstrom E A, Jackson K, Bilali S, Findling R L. New data on the use of lithium, divalproate, and lamotrigine in rapid cycling bipolar disorder. Eur Psychiatry. 2005; 20 (2) 92-95
- 51 Thies-Flechtner K, Müller-Oerlinghausen B, Seibert W, Walther A, Greil W. Effect of prophylactic treatment on suicide risk in patients with major affective disorders. Data from a randomized prospective trial. Pharmacopsychiatry. 1996; 29 (3) 103-107
-
52 Ahrens B, Müller-Oerlinghausen B.
Die antisuizidale und mortalitätssinkende Wirkung von Lithium. In: Müller-Oerlinghausen B, Greil W, Berghöfer A (Hrsg) Die Lithiumtherapie: Nutzen, Risiken, Alternativen. Berlin, Heidelberg; Springer 1997: 262-277 - 53 Schou M. The early European lithium studies. Aust N Z J Psychiatry. 1999; 33, Suppl 39-47
- 54 Tondo L, Jamison K R, Baldessarini R J. Effect of lithium maintenance on suicidal behavior in major mood disorders. Ann N Y Acad Sci. 1997; 836 339-351
- 55 Johnston A M, Eagles J M. Lithium-associated clinical hypothyroidism. Prevalence and risk factors. Br J Psychiatry. 1999; 175 336-339
- 56 Kulhara P, Basu D, Mattoo S K, Sharan P, Chopra R. Lithium prophylaxis of recurrent bipolar affective disorder: long-term outcome and its psychosocial correlates. J Affect Disord. 1999; 54 (1 - 2) 87-96
-
57 Grunze H.
Carbamazepine, other anticonvulsants, antidepressants and augmenting agents. In: Akiskal H, Tohen M (eds) Bipolar Psychopharmacotherapy. Chichester; John Wiley 2005: 63-82 - 58 Greil W, Kleindienst N, Erazo N, Müller-Oerlinghausen B. Differential response to lithium and carbamazepine in the prophylaxis of bipolar disorder. J Clin Psychopharmacol. 1998; 18 455-460
- 59 Hesslinger B, Normann C, Langosch J M, Klose P, Berger M, Walden J. Effects of carbamazepine and valproate on haloperidol plasma levels and on psychopathologic outcome in schizophrenic patients. J Clin Psychopharmacol. 1999; 19 (4) 310-315
- 60 Spina E, Pisani F, Perucca E. Clinically significant pharmacokinetic drug interactions with carbamazepine. An update. Clin Pharmacokinet. 1996; 31 (3) 198-214
- 61 Grunze H, Walden J. Relevance of new and newly rediscovered anticonvulsants for atypical forms of bipolar disorder. J Affect Disord. 2002; 72, Suppl 1 15-21
- 62 Baruzzi A, Albani F, Riva R. Oxcarbazepine: pharmacokinetic interactions and their clinical relevance. Epilepsia. 1994; 35, Suppl 3 14-19
- 63 Gram L. Clinical experience with oxcarbazepine. Epilepsia. 1994; 35, Suppl 3 21-22
- 64 Amelsvoort T Van, Bakshi R, Devaux C B, Schwabe S. Hyponatremia associated with carbamazepine and oxcarbazepine therapy: a review. Epilepsia. 1994; 35 (1) 181-188
-
65 Brennan M J, Sandyk R, Borsook D.
Use of Sodium Valproate in the Management of Affective Disorders: Basic and Clinical Aspects. In: Emrich HM, Okuma T, Müller AA (eds) Anticonvulsants In Affective Disorders. Amsterdam, Oxford, Princeton; Elsevier Science Publishers B. V. EXCERPTA MEDICA, International Congress Series 1984: 56-65 -
66 Lambert P A.
Acute and prophylactic therapies of patients with affective disorders using valpromide (dipropylacetamide). In: Emrich HM, Okuma T, Müller AA (eds) Anticonvulsants in affective disorders. Amsterdam, Oxford, Princeton; Elsevier Science Publishers 1984: 33-44 - 67 Solomon D A, Keitner G I, Ryan C E, Miller I W. Lithium plus valproate as maintenance polypharmacy for patients with bipolar I disorder: a review. J Clin Psychopharmacol. 1998; 18 (1) 38-49
- 68 Denicoff K D, Smith-Jackson E E, Bryan A L, Ali S O, Post R M. Valproate prophylaxis in a prospective clinical trial of refractory bipolar disorder. Am J Psychiatry. 1997; 154 (10) 1456-1458
- 69 Macritchie K A, Geddes J R, Scott J, Haslam D R, Goodwin G M. Valproic acid, valproate and divalproex in the maintenance treatment of bipolar disorder. Cochrane Database Syst Rev 2001 (3) CD003196
- 70 Bowden C. The effectiveness of divalproate in all forms of mania and the broader bipolar spectrum: many questions, few answers. J Affect Disord. 2004; 79, Suppl 1 S9-14
- 71 Rottach K G, Weiss-Brummer J, Wieland U, Schmauss M. Valproinsäure als Phasenprophylaktikum - Ein Fall von Valproat-Enzephalopathie. Nervenarzt. 2000; 71 401-403
- 72 Rasgon N L, Altshuler L L, Fairbanks L, Elman S, Bitran J, Labarca R. et al . Reproductive function and risk for PCOS in women treated for bipolar disorder. Bipolar Disord. 2005; 7 (3) 246-259
- 73 Calabrese J R, Rapport D J, Kimmel S E, Reece B, Woyshville M J. Rapid cycling bipolar disorder and its treatment with valproate. Can J Psychiatry. 1993; 38 (3, Suppl 2) 57-61
- 74 Swann A C, Bowden C L, Morris D, Calabrese J R, Petty F, Small J. et al . Depression during mania. Treatment response to lithium or divalproex. Arch Gen Psychiatry. 1997; 54 (1) 37-42
- 75 McElroy S L, Keck P E, Stanton S P, Tugrul K C, Bennett J A, Strakowski S M. A randomized comparison of divalproex oral loading versus haloperidol in the initial treatment of acute psychotic mania. J Clin Psychiatry. 1996; 57 (4) 142-146
- 76 Vasudev K, Goswami U, Kohli K. Carbamazepine and valproate monotherapy: feasibility, relative safety and efficacy, and therapeutic drug monitoring in manic disorder. Psychopharmacology Berl. 2000; 150 (1) 15-23
- 77 Goodwin G M, Bowden C L, Calabrese J R, Grunze H, Kasper S, White R. et al . A pooled analysis of 2 placebo-controlled 18-month trials of lamotrigine and lithium maintenance in bipolar I disorder. J Clin Psychiatry. 2004; 65 (3) 432-441
- 78 Calabrese J R, Bowden C L, Sachs G S, Ascher J A, Monaghan E, Rudd G. et al . A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. J Clin Psychiatry. 1999; 60 79-88
- 79 Banov M D, Zarate Jr C A, Tohen M, Scialabba D, Wines Jr J D, Kolbrener M. et al . Clozapine therapy in refractory affective disorders: polarity predicts response in long-term follow-up. J Clin Psychiatry. 1994; 55 (7) 295-300
- 80 Calabrese J R, Meltzer H Y, Markovitz P J. Clozapine prophylaxis in rapid cycling bipolar disorder. J Clin Psychopharmacol. 1991; 11 (6) 396-397
- 81 Puri B K, Taylor D G, Alcock M E. Low-dose maintenance clozapine treatment in the prophylaxis of bipolar affective disorder. Br J Clin Pract. 1995; 49 (6) 333-334
- 82 Hummel B, Dittmann S, Forsthoff A, Matzner N, Amann B, Grunze H. Clozapine as add-on medication in the maintenance treatment of bipolar and schizoaffective disorders: a case series. Neuropsychobiology. 2002; 45, Suppl 1 37-42
- 83 Cohen D. Atypical antipsychotics and new onset diabetes mellitus. An overview of the literature. Pharmacopsychiatry. 2004; 37 (1) 1-11
- 84 Seung Kim H F, Weeber E J, Sweatt J D, Stoll A L, Marangell L. Inhibitory effects of omega-3 fatty acids on protein kinase C activity in vitro. Mol Psychiatry. 2001; 6 246-248
- 85 Severus W E, Ahrens B. Omega-3-Fettsäuren in der Psychiatrie. Nervenarzt. 2000; 71 58-62
- 86 Frangou S, Lewis M. The Maudsley Bipolar Disorder Project: a double-blind, randomized, placebo-controlled trial of Ethyl-EPA as an adjunct treatment of depression in bipolar disorder. Bipolar Disord. 2002; 4, suppl 1 123
- 87 Leverich G, Altshuler L, Frye M, Suppes T, McElroy S, Keck P. et al .Antidepressant Augmentation in Bipolar Depression: A Higher Ratio of Full Switches to Subthreshold Hypomanias on Venlafaxine than Sertraline or Bupropion in Acute and Continuation Trials. Am J Psychiatry in press
- 88 Wehr T A, Goodwin F K. Rapid cycling in manic-depressives induced by tricyclic antidepressants. Arch Gen Psychiatry. 1979; 36 (5) 555-559
- 89 Tondo L, Laddomada P, Serra G, Minnai G, Kukopulos A. Rapid cyclers and antidepressants. Int Pharmacopsychiatry. 1981; 16 (2) 119-123
- 90 Altshuler L L, Post R M, Leverich G S, Mikalauskas K, Rosoff A, Ackerman L. Antidepressant-induced mania and cycle acceleration: a controversy revisited. Am J Psychiatry. 1995; 152 (8) 1130-1138
- 91 Vieta E, Martínez-Arán A, Colom F, Benabarre A, Reinares M, Gastó C. Treatment of bipolar depression: paroxetine vs. venlafaxine. Int J Neuropsychopharmacol. 2000; 3, Suppl 1 336-337
- 92 Walden J, Schaerer L O, Schlösser S, Grunze H. An open longitidinal study of patients with bipolar rapid cycling treated with lithium or lamotrigine for mood stabilzation. Bipolar disorders. 2000; 2 336-339
- 93 Abou-Saleh M T, Coppen A. Who responds to prophylactic lithium?. J Affect Disord. 1986; 10 (2) 115-125
- 94 Maj M. Clinical prediction of response to lithium prophylaxis in bipolar patients: the importance of the previous pattern of course of the illness. Clin Neuropharmacol. 1990; 13, Suppl 1 66-70
- 95 Tondo L, Baldessarini R J. Rapid cycling in women and men with bipolar manic-depressive disorders. Am J Psychiatry. 1998; 155 (10) 1434-1436
- 96 Okuma T, Kishimoto A, Inoue K, Matsumoto H, Ogura A. Anti-manic and prophylactic effects of carbamazepine (Tegretol) on manic depressive psychosis. A preliminary report. Folia Psychiatr Neurol Jpn. 1973; 27 (4) 283-297
- 97 Fujiwara Y, Honda T, Tanaka Y, Aoki S, Kuroda S. Comparison of early- and late-onset rapid cycling affective disorders: clinical course and response to pharmacotherapy. J Clin Psychopharmacol. 1998; 18 (4) 282-288
- 98 Okuma T. Effects of carbamazepine and lithium on affective disorders. Neuropsychobiology. 1993; 27 (3) 138-145
- 99 Joyce P R. Carbamazepine in rapid cycling bipolar affective disorder. Int Clin Psychopharmacol. 1988; 3 (2) 123-129
- 100 Pazzaglia P, Post R M, Ketter T A, Callahan A M, Marangell L B, Frye M A. et al . Nimodipine monotherapy and carbamazepine augmentation in patients with refractory recurrent affective illness. J Clin Psychopharmacol. 1998; 18 (5) 404-413
- 101 Bauer M S, Whybrow P C. Rapid cycling bipolar affective disorder. II. Treatment of refractory rapid cycling with high-dose levothyroxine: a preliminary study. Arch Gen Psychiatry. 1990; 47 (5) 435-440
- 102 Post R M, Ketter T A, Pazzaglia P J, Denicoff K, George M S, Callahan A. et al . Rational polypharmacy in the bipolar affective disorders. Epilepsy Res. 1996; 11, Suppl 153-180
- 103 Frye M A, Ketter T A, Leverich G S, Huggins T, Lantz C, Denicoff K D. et al . The increasing use of polypharmacotherapy for refractory mood disorders: 22 years of study. J Clin Psychiatry. 2000; 61 (1) 9-15
- 104 Solomon D A, Ryan C E, Keitner G I, Miller I W, Shea M T, Kazim A. et al . A pilot study of lithium carbonate plus divalproex sodium for the continuation and maintenance treatment of patients with bipolar I disorder. J Clin Psychiatry. 1997; 58 (3) 95-99
- 105 Baethge C, Baldessarini R J, Mathiske-Schmidt K, Hennen J, Berghofer A, Muller-Oerlinghausen B. et al . Long-term combination therapy versus monotherapy with lithium and carbamazepine in 46 bipolar I patients. J Clin Psychiatry. 2005; 66 (2) 174-182
- 106 Denicoff K D, Smith-Jackson E E, Disney E R, Ali S O, Leverich G S, Post R M. Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in bipolar disorder. J Clin Psychiatry. 1997; 58 (11) 470-478
- 107 Greil W, Ludwig-Mayerhofer W, Erazo N, Engel R R, Czernik A, Giedke H. et al . Lithium vs carbamazepine in the maintenance treatment of schizoaffective disorder: a randomised study. Eur Arch Psychiatry Clin Neurosci. 1997; 247 (1) 42-50
- 108 Ciapparelli A, Dell'Osso L, Pini S, Chiavacci M C, Fenzi M, Cassano G B. Clozapine for treatment-refractory schizophrenia, schizoaffective disorder, and psychotic bipolar disorder: a 24-month naturalistic study. J Clin Psychiatry. 2000; 61 (5) 329-334
- 109 Basco M R, Rush A J. Cognitive Behavioral Therapy for Bipolar Disorder. New York; Guildford Press 1996
- 110 Leverich G S, Post R M. Life charting the course of bipolar disorder. Current review of Mood & Anxiety disorders. 1996; 1 48-61
Dr. med. Heinz Grunze
Psychiatrische Klinik der LMU
Nussbaumstraße 7
80336 München
Email: Heinz.Grunze@med.uni-muenchen.de