Class effect of pharmacotherapy in bipolar disorder: Fact or misbelief?

Konstantinos N. Fountoulakis, X. Gonda, Eduard Vieta, Z. Ríhmer

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Anecdotal reports suggests that most clinicians treat medications as belonging to a class with regard to all therapeutic indications; this means that the whole 'class' of drugs is considered to possesses a specific therapeutic action. The present article explores the possible existence of a true 'class effect' for agents available for the treatment of bipolar disorder.Methods: We reviewed the available treatment data from randomized controlled trials (RCTs) and explored 16 'agent class'/'treatment issue' cases for bipolar disorder. Four classes of agents were examined: first-generation antipsychotics (FGAs), second-generation antipsychotics (SGAs), antiepileptics and antidepressants, with respect to their efficacy on four treatment issues of bipolar disorder (BD) (acute mania, acute bipolar depression, maintenance against mania, maintenance against depression).Results: From the 16 'agent class'/' treatment issue' cases, only 3 possible class effects were detected, and they all concerned acute mania and antipsychotics. Four effect cases have not been adequately studied (FGAs against acute bipolar depression and in maintenance protection from depression, and antidepressants against acute mania and protection from mania) and they all concern treatment cases with a high risk of switching to the opposite pole, thus research in these areas is poor. There is no 'class effect' at all concerning antiepileptics.Conclusions: The available data suggest that a 'class effect' is the exception rather than the rule in the treatment of BD. However, the possible presence of a 'class effect' concept discourages clinicians from continued scientific training and reading. Focused educational intervention might be necessary to change this attitude.

Original languageEnglish
Article number8
JournalAnnals of General Psychiatry
Volume10
DOIs
Publication statusPublished - Mar 24 2011

Fingerprint

Bipolar Disorder
Drug Therapy
Antipsychotic Agents
Maintenance
Therapeutics
Anticonvulsants
Antidepressive Agents
Depression
Reading
Randomized Controlled Trials

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Class effect of pharmacotherapy in bipolar disorder : Fact or misbelief? / Fountoulakis, Konstantinos N.; Gonda, X.; Vieta, Eduard; Ríhmer, Z.

In: Annals of General Psychiatry, Vol. 10, 8, 24.03.2011.

Research output: Contribution to journalArticle

@article{ae100f2cb7a84c5998ba5549cdcc5d9e,
title = "Class effect of pharmacotherapy in bipolar disorder: Fact or misbelief?",
abstract = "Background: Anecdotal reports suggests that most clinicians treat medications as belonging to a class with regard to all therapeutic indications; this means that the whole 'class' of drugs is considered to possesses a specific therapeutic action. The present article explores the possible existence of a true 'class effect' for agents available for the treatment of bipolar disorder.Methods: We reviewed the available treatment data from randomized controlled trials (RCTs) and explored 16 'agent class'/'treatment issue' cases for bipolar disorder. Four classes of agents were examined: first-generation antipsychotics (FGAs), second-generation antipsychotics (SGAs), antiepileptics and antidepressants, with respect to their efficacy on four treatment issues of bipolar disorder (BD) (acute mania, acute bipolar depression, maintenance against mania, maintenance against depression).Results: From the 16 'agent class'/' treatment issue' cases, only 3 possible class effects were detected, and they all concerned acute mania and antipsychotics. Four effect cases have not been adequately studied (FGAs against acute bipolar depression and in maintenance protection from depression, and antidepressants against acute mania and protection from mania) and they all concern treatment cases with a high risk of switching to the opposite pole, thus research in these areas is poor. There is no 'class effect' at all concerning antiepileptics.Conclusions: The available data suggest that a 'class effect' is the exception rather than the rule in the treatment of BD. However, the possible presence of a 'class effect' concept discourages clinicians from continued scientific training and reading. Focused educational intervention might be necessary to change this attitude.",
author = "Fountoulakis, {Konstantinos N.} and X. Gonda and Eduard Vieta and Z. R{\'i}hmer",
year = "2011",
month = "3",
day = "24",
doi = "10.1186/1744-859X-10-8",
language = "English",
volume = "10",
journal = "Annals of General Psychiatry",
issn = "1744-859X",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Class effect of pharmacotherapy in bipolar disorder

T2 - Fact or misbelief?

AU - Fountoulakis, Konstantinos N.

AU - Gonda, X.

AU - Vieta, Eduard

AU - Ríhmer, Z.

PY - 2011/3/24

Y1 - 2011/3/24

N2 - Background: Anecdotal reports suggests that most clinicians treat medications as belonging to a class with regard to all therapeutic indications; this means that the whole 'class' of drugs is considered to possesses a specific therapeutic action. The present article explores the possible existence of a true 'class effect' for agents available for the treatment of bipolar disorder.Methods: We reviewed the available treatment data from randomized controlled trials (RCTs) and explored 16 'agent class'/'treatment issue' cases for bipolar disorder. Four classes of agents were examined: first-generation antipsychotics (FGAs), second-generation antipsychotics (SGAs), antiepileptics and antidepressants, with respect to their efficacy on four treatment issues of bipolar disorder (BD) (acute mania, acute bipolar depression, maintenance against mania, maintenance against depression).Results: From the 16 'agent class'/' treatment issue' cases, only 3 possible class effects were detected, and they all concerned acute mania and antipsychotics. Four effect cases have not been adequately studied (FGAs against acute bipolar depression and in maintenance protection from depression, and antidepressants against acute mania and protection from mania) and they all concern treatment cases with a high risk of switching to the opposite pole, thus research in these areas is poor. There is no 'class effect' at all concerning antiepileptics.Conclusions: The available data suggest that a 'class effect' is the exception rather than the rule in the treatment of BD. However, the possible presence of a 'class effect' concept discourages clinicians from continued scientific training and reading. Focused educational intervention might be necessary to change this attitude.

AB - Background: Anecdotal reports suggests that most clinicians treat medications as belonging to a class with regard to all therapeutic indications; this means that the whole 'class' of drugs is considered to possesses a specific therapeutic action. The present article explores the possible existence of a true 'class effect' for agents available for the treatment of bipolar disorder.Methods: We reviewed the available treatment data from randomized controlled trials (RCTs) and explored 16 'agent class'/'treatment issue' cases for bipolar disorder. Four classes of agents were examined: first-generation antipsychotics (FGAs), second-generation antipsychotics (SGAs), antiepileptics and antidepressants, with respect to their efficacy on four treatment issues of bipolar disorder (BD) (acute mania, acute bipolar depression, maintenance against mania, maintenance against depression).Results: From the 16 'agent class'/' treatment issue' cases, only 3 possible class effects were detected, and they all concerned acute mania and antipsychotics. Four effect cases have not been adequately studied (FGAs against acute bipolar depression and in maintenance protection from depression, and antidepressants against acute mania and protection from mania) and they all concern treatment cases with a high risk of switching to the opposite pole, thus research in these areas is poor. There is no 'class effect' at all concerning antiepileptics.Conclusions: The available data suggest that a 'class effect' is the exception rather than the rule in the treatment of BD. However, the possible presence of a 'class effect' concept discourages clinicians from continued scientific training and reading. Focused educational intervention might be necessary to change this attitude.

UR - http://www.scopus.com/inward/record.url?scp=79953117256&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953117256&partnerID=8YFLogxK

U2 - 10.1186/1744-859X-10-8

DO - 10.1186/1744-859X-10-8

M3 - Article

C2 - 21435226

AN - SCOPUS:79953117256

VL - 10

JO - Annals of General Psychiatry

JF - Annals of General Psychiatry

SN - 1744-859X

M1 - 8

ER -