Monitoring bipolar treatments: new guidelines

New guidelines sponsored by the International Society for Bipolar Disorders (ISBD) emphasise the multiple benefits of monitoring physical health in people treated with mood stabilisers. “Safety monitoring...may have the dual benefit of detecting prevalent medical comorbidities and minimising the morbidity and mortality that result from adverse drug reactions,” they state. The guidelines were developed by an ISBD working group in which the senior author was Professor Michael Berk from the University of Melbourne, who is also the Society’s president. They are limited to medications with established mood-stabilising properties including lithium, valproate, carbamazepine, lamotrigine and the atypical antipsychotics. A general algorithm recommends the baseline parameters that should be established before starting treatment, including a comprehensive medical history emphasising comorbidities, cardiovascular risk factors, alcohol use and reproductive status, and basic laboratory investigations. Detailed recommendations are provided for each class of medication, including the need for monitoring serum levels when appropriate, drug interactions, and regular reviews of physical health. “A recent audit of therapeutic drug level and cardiovascular risk monitoring in bipolar disorder found that only about half of the patients were receiving monitoring according to the minimal recommendations of US guidelines,” the authors noted. Potential barriers to monitoring included a paucity of guidelines, problems with insight or adherence on the part of the patient, and the common segregation of psychiatric care from other medical care. Bipolar Disorders 2009; 11: 559-595....