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International Journal of Bipolar Disorders

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Open Access 01-12-2016 | Review

Is treatment for bipolar disorder more effective earlier in illness course? A comprehensive literature review

Authors: Katie Joyce, Andrew Thompson, Steven Marwaha

Published in: International Journal of Bipolar Disorders | Issue 1/2016

Abstract

Background

We aimed to investigate a key element of the early intervention approach; whether treatment at an earlier stage of bipolar disorder is more effective than later in its course.

Methods

A comprehensive literature review using Medline, Embase, Psychinfo, PsycArticle and Web of Science as data sources, with a subsequent narrative synthesis. Study quality was assessed using the Cochrane risk of bias method.

Results

Our search strategy yielded eight primary papers and two meta-analyses (of psychological therapies and Olanzapine) in total representing 8942 patients. Five studies focused on comparisons between first and multiple episode; the others on fewer vs more episode categories. There was a consistent finding suggesting treatment in earlier illness stage resulted in better outcomes in terms of response, relapse rate, time to recurrence, symptomatic recovery, remission, psychosocial functioning and employment. This effect was found for pharmacological (Lithium, Olanzapine, Divalproex) and psychological treatment.

Limitations

There was high risk of selection, performance and attrition bias in most studies. First admission or presentation is unlikely to equate to first episode because of duration of untreated illness. Some patients having experienced multiple episodes could be “treatment resistant”. Study heterogeneity precluded meta-analysis.

Conclusions

Psychological and pharmacological treatment in the early stages of illness is more effective than in later stages of bipolar disorder across multiple domains. There is a first episode and early phase effect. Consistent with the staging model of illness findings provide evidence for the clinical utility of an early intervention approach in bipolar disorder to improve patient outcomes.

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Title: Is treatment for bipolar disorder more effective earlier in illness course? A comprehensive literature review
Authors: Katie Joyce
Andrew Thompson
Steven Marwaha
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Bipolar Disorders / Issue 1/2016
Electronic ISSN: 2194-7511
DOI: https://doi.org/10.1186/s40345-016-0060-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is treatment for bipolar disorder more effective earlier in illness course? A comprehensive literature review

Abstract

Background

Methods

Results

Limitations

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Limitations

Conclusions

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