A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention

A. Ratheesh; D. Hett; J. Ramain; E. Wong; L. Berk; P. Conus; M. A. Fristad; T. Goldstein; M. Hillegers; S. Jauhar; L. V. Kessing; D. J. Miklowitz; G. Murray; M. Tohen; L. N. Yatham; A. H. Young; M. Berk; S. Marwaha; Jan L Scott

doi:10.1186/s40345-022-00275-3

A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention

A. Ratheesh^*, D. Hett, J. Ramain, E. Wong, L. Berk, P. Conus, M. A. Fristad, T. Goldstein, M. Hillegers, S. Jauhar, L. V. Kessing, D. J. Miklowitz, G. Murray, M. Tohen, L. N. Yatham, A. H. Young, M. Berk, S. Marwaha, Jan L Scott

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

Abstract

Background: Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We conducted a systematic review of the effectiveness of interventions in the early course of BD I or II.

Methods: We completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the ‘early course’ of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach.

Results: From 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course.

Conclusions and recommendations: While there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness course. Specifically, there is a compelling need to compare the relative benefits of lithium with other pharmacological agents in preventing recurrences. In addition to symptomatic outcomes, there should be a greater focus on functional impact and tolerability. Effective pharmacological and psychological interventions should be offered to those in early course of BD, balancing potential risks using shared decision-making approaches.

Original language	English
Article number	1
Number of pages	24
Journal	International journal of bipolar disorders
Volume	11
Issue number	1
DOIs	https://doi.org/10.1186/s40345-022-00275-3
Publication status	Published - 3 Jan 2023

Bibliographical note

Funding Information:
MB is supported by a NHMRC Senior Principal Research Fellowship (1156072). MB has received 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, has been a speaker for Abbot, Astra Zeneca, Janssen and Janssen, Lundbeck and Merck and served as a consultant to Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Eisai, Janssen and Janssen, Lundbeck Merck, Pfizer and Servier—all unrelated to this work. LVK has within recent three years been a consultant for Teva and Lundbeck. SJ has received speaker fees for educational talks given for Jannsen, Lundbeck and Sunovian. MT was an employee of Lilly (1997 to 2008) and has received honoraria from or consulted for Abbott, Abvvie, AstraZeneca, Alkermes, Allergan, Bristol Myers Squibb, GlaxoSmithKline, Lilly, Johnson & Johnson, Otsuka, Merck, Gedeon Richter Plc, Sunovion, Intracellular Therapies, Forest, Roche, Elan, Lundbeck, Teva, Pamlab, Minerva, Neurocrine, Pfizer, and Wiley Publishing; his spouse was a full time employee at Lilly (1998–2013). DJM receives research support from the NIMH, the Danny Alberts Foundation, Attias Family Foundation, Carl and Roberta Deutsch Foundation, Kayne Family Foundation, AIM for Mental Health, and Max Gray Fund; and book royalties from Guilford Press and John Wiley and Sons. MAF receives royalties from American Psychiatric Publishing and Guilford Press, research support from Janssen, and an editorial stipend from the Society of Clinical Child and Adolescent Psychology. AY has been paid for lectures and advisory boards for the following companies with drugs used in affective and related disorders: Astrazenaca, Eli Lilly, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS, Sage, Novartis. He has been a consultant for Johnson & Johnson and Livanova. He has received honoraria for attending advisory boards and presenting talks at meetings organised by LivaNova, and has been the principal Investigator in the Restore-Life VNS registry study funded by LivaNova. He has also been a principal or chief Investigator on ESKETINTRD3004, Novartis MDD study MIJ821A12201, and trials on psilocybin. He has received grant funding (past and present) from: NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edin); BMA (UK); UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); NIHR (UK). Janssen (UK). He has no shareholdings in pharmaceutical companies. Professor Young’s independent research is funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. AR is supported by an NHMRC (Australia) Early Career Fellowship. The other authors have no conflicts to declare.

Publisher Copyright:
© 2023, The Author(s).

Keywords

Antipsychotics
Bipolar disorder
CBT
Course
Depression
Early intervention
Lithium
Mania
Mood stabilisers
Psychoeducation
Recurrence
Remission
Systematic review

ASJC Scopus subject areas

Psychiatry and Mental health
Biological Psychiatry

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Ratheesh, A., Hett, D., Ramain, J., Wong, E., Berk, L., Conus, P., Fristad, M. A., Goldstein, T., Hillegers, M., Jauhar, S., Kessing, L. V., Miklowitz, D. J., Murray, G., Tohen, M., Yatham, L. N., Young, A. H., Berk, M., Marwaha, S., & Scott, J. L. (2023). A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention. International journal of bipolar disorders, 11(1), Article 1. https://doi.org/10.1186/s40345-022-00275-3

@article{2474a31cb3334807a5faaeb108c6bd11,

title = "A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention",

abstract = "Background: Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We conducted a systematic review of the effectiveness of interventions in the early course of BD I or II. Methods: We completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the {\textquoteleft}early course{\textquoteright} of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach. Results: From 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course. Conclusions and recommendations: While there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness course. Specifically, there is a compelling need to compare the relative benefits of lithium with other pharmacological agents in preventing recurrences. In addition to symptomatic outcomes, there should be a greater focus on functional impact and tolerability. Effective pharmacological and psychological interventions should be offered to those in early course of BD, balancing potential risks using shared decision-making approaches.",

keywords = "Antipsychotics, Bipolar disorder, CBT, Course, Depression, Early intervention, Lithium, Mania, Mood stabilisers, Psychoeducation, Recurrence, Remission, Systematic review",

author = "A. Ratheesh and D. Hett and J. Ramain and E. Wong and L. Berk and P. Conus and Fristad, {M. A.} and T. Goldstein and M. Hillegers and S. Jauhar and Kessing, {L. V.} and Miklowitz, {D. J.} and G. Murray and M. Tohen and Yatham, {L. N.} and Young, {A. H.} and M. Berk and S. Marwaha and Scott, {Jan L}",

note = "Funding Information: MB is supported by a NHMRC Senior Principal Research Fellowship (1156072). MB has received 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, has been a speaker for Abbot, Astra Zeneca, Janssen and Janssen, Lundbeck and Merck and served as a consultant to Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Eisai, Janssen and Janssen, Lundbeck Merck, Pfizer and Servier—all unrelated to this work. LVK has within recent three years been a consultant for Teva and Lundbeck. SJ has received speaker fees for educational talks given for Jannsen, Lundbeck and Sunovian. MT was an employee of Lilly (1997 to 2008) and has received honoraria from or consulted for Abbott, Abvvie, AstraZeneca, Alkermes, Allergan, Bristol Myers Squibb, GlaxoSmithKline, Lilly, Johnson & Johnson, Otsuka, Merck, Gedeon Richter Plc, Sunovion, Intracellular Therapies, Forest, Roche, Elan, Lundbeck, Teva, Pamlab, Minerva, Neurocrine, Pfizer, and Wiley Publishing; his spouse was a full time employee at Lilly (1998–2013). DJM receives research support from the NIMH, the Danny Alberts Foundation, Attias Family Foundation, Carl and Roberta Deutsch Foundation, Kayne Family Foundation, AIM for Mental Health, and Max Gray Fund; and book royalties from Guilford Press and John Wiley and Sons. MAF receives royalties from American Psychiatric Publishing and Guilford Press, research support from Janssen, and an editorial stipend from the Society of Clinical Child and Adolescent Psychology. AY has been paid for lectures and advisory boards for the following companies with drugs used in affective and related disorders: Astrazenaca, Eli Lilly, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS, Sage, Novartis. He has been a consultant for Johnson & Johnson and Livanova. He has received honoraria for attending advisory boards and presenting talks at meetings organised by LivaNova, and has been the principal Investigator in the Restore-Life VNS registry study funded by LivaNova. He has also been a principal or chief Investigator on ESKETINTRD3004, Novartis MDD study MIJ821A12201, and trials on psilocybin. He has received grant funding (past and present) from: NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edin); BMA (UK); UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); NIHR (UK). Janssen (UK). He has no shareholdings in pharmaceutical companies. Professor Young{\textquoteright}s independent research is funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King{\textquoteright}s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. AR is supported by an NHMRC (Australia) Early Career Fellowship. The other authors have no conflicts to declare. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = jan,

day = "3",

doi = "10.1186/s40345-022-00275-3",

language = "English",

volume = "11",

journal = "International journal of bipolar disorders",

issn = "2194-7511",

publisher = "Springer Open",

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Ratheesh, A, Hett, D, Ramain, J, Wong, E, Berk, L, Conus, P, Fristad, MA, Goldstein, T, Hillegers, M, Jauhar, S, Kessing, LV, Miklowitz, DJ, Murray, G, Tohen, M, Yatham, LN, Young, AH, Berk, M, Marwaha, S & Scott, JL 2023, 'A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention', International journal of bipolar disorders, vol. 11, no. 1, 1. https://doi.org/10.1186/s40345-022-00275-3

A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention. / Ratheesh, A.; Hett, D.; Ramain, J. et al.
In: International journal of bipolar disorders, Vol. 11, No. 1, 1, 03.01.2023.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - A systematic review of interventions in the early course of bipolar disorder I or II

T2 - a report of the International Society for Bipolar Disorders Taskforce on early intervention

AU - Ratheesh, A.

AU - Hett, D.

AU - Ramain, J.

AU - Wong, E.

AU - Berk, L.

AU - Conus, P.

AU - Fristad, M. A.

AU - Goldstein, T.

AU - Hillegers, M.

AU - Jauhar, S.

AU - Kessing, L. V.

AU - Miklowitz, D. J.

AU - Murray, G.

AU - Tohen, M.

AU - Yatham, L. N.

AU - Young, A. H.

AU - Berk, M.

AU - Marwaha, S.

AU - Scott, Jan L

N1 - Funding Information: MB is supported by a NHMRC Senior Principal Research Fellowship (1156072). MB has received 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, has been a speaker for Abbot, Astra Zeneca, Janssen and Janssen, Lundbeck and Merck and served as a consultant to Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Eisai, Janssen and Janssen, Lundbeck Merck, Pfizer and Servier—all unrelated to this work. LVK has within recent three years been a consultant for Teva and Lundbeck. SJ has received speaker fees for educational talks given for Jannsen, Lundbeck and Sunovian. MT was an employee of Lilly (1997 to 2008) and has received honoraria from or consulted for Abbott, Abvvie, AstraZeneca, Alkermes, Allergan, Bristol Myers Squibb, GlaxoSmithKline, Lilly, Johnson & Johnson, Otsuka, Merck, Gedeon Richter Plc, Sunovion, Intracellular Therapies, Forest, Roche, Elan, Lundbeck, Teva, Pamlab, Minerva, Neurocrine, Pfizer, and Wiley Publishing; his spouse was a full time employee at Lilly (1998–2013). DJM receives research support from the NIMH, the Danny Alberts Foundation, Attias Family Foundation, Carl and Roberta Deutsch Foundation, Kayne Family Foundation, AIM for Mental Health, and Max Gray Fund; and book royalties from Guilford Press and John Wiley and Sons. MAF receives royalties from American Psychiatric Publishing and Guilford Press, research support from Janssen, and an editorial stipend from the Society of Clinical Child and Adolescent Psychology. AY has been paid for lectures and advisory boards for the following companies with drugs used in affective and related disorders: Astrazenaca, Eli Lilly, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS, Sage, Novartis. He has been a consultant for Johnson & Johnson and Livanova. He has received honoraria for attending advisory boards and presenting talks at meetings organised by LivaNova, and has been the principal Investigator in the Restore-Life VNS registry study funded by LivaNova. He has also been a principal or chief Investigator on ESKETINTRD3004, Novartis MDD study MIJ821A12201, and trials on psilocybin. He has received grant funding (past and present) from: NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edin); BMA (UK); UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); NIHR (UK). Janssen (UK). He has no shareholdings in pharmaceutical companies. Professor Young’s independent research is funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. AR is supported by an NHMRC (Australia) Early Career Fellowship. The other authors have no conflicts to declare. Publisher Copyright: © 2023, The Author(s).

PY - 2023/1/3

Y1 - 2023/1/3

N2 - Background: Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We conducted a systematic review of the effectiveness of interventions in the early course of BD I or II. Methods: We completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the ‘early course’ of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach. Results: From 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course. Conclusions and recommendations: While there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness course. Specifically, there is a compelling need to compare the relative benefits of lithium with other pharmacological agents in preventing recurrences. In addition to symptomatic outcomes, there should be a greater focus on functional impact and tolerability. Effective pharmacological and psychological interventions should be offered to those in early course of BD, balancing potential risks using shared decision-making approaches.

AB - Background: Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We conducted a systematic review of the effectiveness of interventions in the early course of BD I or II. Methods: We completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the ‘early course’ of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach. Results: From 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course. Conclusions and recommendations: While there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness course. Specifically, there is a compelling need to compare the relative benefits of lithium with other pharmacological agents in preventing recurrences. In addition to symptomatic outcomes, there should be a greater focus on functional impact and tolerability. Effective pharmacological and psychological interventions should be offered to those in early course of BD, balancing potential risks using shared decision-making approaches.

KW - Antipsychotics

KW - Bipolar disorder

KW - CBT

KW - Course

KW - Depression

KW - Early intervention

KW - Lithium

KW - Mania

KW - Mood stabilisers

KW - Psychoeducation

KW - Recurrence

KW - Remission

KW - Systematic review

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U2 - 10.1186/s40345-022-00275-3

DO - 10.1186/s40345-022-00275-3

M3 - Review article

AN - SCOPUS:85145605625

SN - 2194-7511

VL - 11

JO - International journal of bipolar disorders

JF - International journal of bipolar disorders

IS - 1

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ER -

A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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