Treatment of Prodromal Bipolar Disorder

Long-term pharmacotherapy should be initiated after a single manic episode, together with psychosocial support.6 Lithium monotherapy is a first-line treatment, effective against both manic and depressive relapse. Combination treatment is recommended when monotherapy fails or subsyndromal symptoms are ongoing. Adjunctive antimanic agents (e.g., valproate and/or antipsychotics] for manic symptoms, and lamotrigine or quetiapine for predominantly depressive symptoms should be utilized.6 Antidepressant monotherapy is not recommended, due to increased risk of manic switch. Helpful nonpharmacologic interventions include cognitive behavioral therapy (CBT) and psychoeducation.6

The authors conclude, “a substantial and growing body of evidence exists that bipolar disorder . . . has a number of early clinical, biological, and neuropsychological features, which may represent a prodromal state and predict onset of the disorder.” They note that early diagnosis and treatment of BD may introduce “stigmatization and unnecessary side effects from the use of potentially harmful psychotropic medication.” However, “the benefits of robust early identification and intervention services are likely to outweigh these possible disadvantages.”


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