Bipolar disorder affects approximately 8 million adults in the US and approximately 40 million individuals worldwide.
Bipolar disorder is characterized by recurrent episodes of depression and mania or hypomania. Bipolar depressive episodes are similar to major depressive episodes. Manic and hypomanic episodes are characterized by a distinct change in mood and behavior during discrete time periods. The age of onset is usually between 15 and 25 years, and depression is the most frequent initial presentation. Approximately 75% of symptomatic time consists of depressive episodes or symptoms. Early diagnosis and treatment are associated with a more favorable prognosis. Diagnosis and optimal treatment are often delayed by a mean of approximately 9 years following an initial depressive episode. Long-term treatment consists of mood stabilizers, such as lithium, valproate, and lamotrigine. Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are recommended, but some are associated with weight gain. Antidepressants are not recommended as monotherapy. More than 50% of patients with bipolar disorder are not adherent to treatment. Life expectancy is reduced by approximately 12 to 14 years in people with bipolar disorder, with a 1.6-fold to 2-fold increase in cardiovascular mortality occurring a mean of 17 years earlier compared with the general population. Prevalence rates of metabolic syndrome (37%), obesity (21%), cigarette smoking (45%), and type 2 diabetes (14%) are higher among people with bipolar disorder, contributing to the risk of early mortality. The annual suicide rate is approximately 0.9% among individuals with bipolar disorder, compared with 0.014% in the general population. Approximately 15% to 20% of people with bipolar disorder die by suicide.
Conclusions and Relevance
Bipolar disorder affects approximately 8 million adults in the US. First-line therapy includes mood stabilizers, such as lithium, anticonvulsants, such as valproate and lamotrigine, and atypical antipsychotic drugs, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine.
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Accepted for Publication: August 30, 2023.
Corresponding Author: Andrew A. Nierenberg, MD, Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, 50 Staniford St, Suite 580, Boston, MA 02114 (firstname.lastname@example.org).
Conflict of Interest Disclosures: Dr Nierenberg reported serving on an adjudication committee for Novartis; consulting for Alkermes, Clexio, Ginger/Headspace Health, Janssen, Merck, Neuronetics, NeuroRx, Otsuka, Protagenics, SAGE, Sunovion, and Unravel Bioscience; receiving honoraria from Belvior, EISAI, Psychiatric Annals Slack Publications, Wiley Depression and Anxiety, Guilford Publications, and Up-to-Date Wolters Kluwer Health; and serving on a scientific advisory board for Altimate, Flow, Milken Center for Strategic Philanthropy, Myriad, and 4M Therapeutics outside the submitted work. Dr Cusin reported receiving grants from Janssen, Otsuka, Clexio, and Shenox and personal fees from Perception and serving on a data and safety monitoring board for Alkermes outside the submitted work. Dr Sylvia reported receiving personal fees from New Harbinger and grants from PCORI and NIMH outside the submitted work. Dr Berk is supported by a NHMRC Senior Principal Research Fellowship (1059660 and 1156072) and reported receiving grant/research support from the NIH, Cooperative Research Centre, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, Medical Benefits Fund, National Health and Medical Research Council, Medical Research Futures Fund, Beyond Blue, Rotary Health, A2 milk company, Meat and Livestock Board, Woolworths, Avant, and the Harry Windsor Foundation; serving as a speaker for AstraZeneca, Lundbeck, Merck, and Pfizer; and serving as a consultant to Allergan, AstraZeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Lundbeck Merck, Pfizer, and Servier outside the submitted work. No other disclosures were reported.
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