Barcelona snapshots

Prof. Eduard Vieta

Eduard Vieta psychiatrist PAIS Controversias Psiquiatry Barcelona
Universitat de Barcelona, Spain
Talk Bipolar depression and rapid cycling
Date Friday, April 20th, 2018
Time 17:15 to 18:00
Table Complexities in Psychiatry: psychosis and bipolar disorders

BIOGRAPHY

Eduard Vieta is Professor of Psychiatry at the University of Barcelona and Chair of the Department of Psychiatry and Psychology at the Hospital Clinic, where he also leads the Bipolar Disorders Program in Barcelona, Catalonia, Spain. His unit is one of the worldwide leaders in clinical care, teaching and research on bipolar disorder. Dr. Vieta is also the current Scientific Director of the Spanish Research Network on Mental Health (CIBERSAM). He has received the Aristotle award (2005), the Mogens Schou award (2007), the Strategic Research award of the Spanish Society of Biological Psychiatry (2009), the Official College of Physicians award to Professional Excellence (2011), the Colvin Price on Outstanding Achievement in Mood Disorders Research by the Brain and Behaviour Research Foundation (2012), the Clinical Neuroscience Lilly award by the International College of Neuropsychopharmacology (CINP 2014), the Simon Bolivar Award (American Psychiatric Association 2017) and the Research Price of the World Federation of Societies of Biological Psychiatry (WFSBP, 2017). He has been named best psychiatrist in Spain (Monitor sanitario) and Doctor Honoris Causa by the University of Valencia. He is currently the treasurer of the European College of Neuropsychopharmacology (ECNP).

He has authored more than 700 original articles, 410 book chapters and 38 books. His H index is 85 and has over 28000 citations, which makes him the most cited scientist worldwide in the field of bipolar disorder over the last 8 years and one of the world’s most influential scientific minds, according to Thompson Reuters ranking (Highly Cited). Furthermore, he is on the editorial board of many scientific journals and has served as invited professor at McLean Hospital and Harvard University and as neuroscience scientific advisor to the European Presidency.

ABSTRACT

The importance of reaching an accurate diagnosis and the efficacy of available treatment options in patients with bipolar depression are crucial for an appropriate treatment plan. Antidepressants are poorly evidence based for the treatment of bipolar depression. Drugs such as lithium, lamotrigine, the combination of olanzapine with fluoxetine, quetiapine, lurasidone and cariprazine have positive data and may be more appropriate as first-line in many cases. Rapid cycling is a course specifier that may be spontaneous or the result of some treatments such as antidepressants in vulnerable patients. The treatment of rapid cycling can be extremely complex.

The mechanisms of action of atypical antipsychotics that have demonstrated some evidence to support their efficacy in both bipolar mania and bipolar depression, have not been fully elucidated; however, antagonism of dopamine D2 receptors is believed to underlie their antipsychotic and antimanic activity. The mechanisms by which atypical antipsychotics improve symptoms in bipolar depression is likely to be multifactorial, comprise several neurological pathways and involve dopamine D2 receptors, 5-HT receptors, α2-adrenergic receptors and the noradrenaline transporter (NET). In contrast to other classes of medication, including conventional antipsychotics and serotonin noradrenaline reuptake inhibitors (SNRIs), individual atypical antipsychotics differ considerably in their mechanisms of action and binding affinities for several neuroreceptors.

A pivotal step in our goal of improving patient outcomes in bipolar disorder is understanding the range of clinical benefits that can be achieved with different therapeutic options. As a class, the atypical antipsychotics comprise a diverse group of drugs with different efficacy profiles and contrasting pharmacological properties. As such, atypical antipsychotics should be considered on an agent-by-agent basis rather than perceived as a homogenous group. Their combination with lithium and/or other mood stabilisers may be the treatment of choice in rapid cyclers. Antidepressats should only be prescribed in certain patients, on a case-by-case basis. Other interventions, such as electroconvulsive therapy, ketamine and newer compounds may be used in treatment-resistant cases. Psychoeducation and functional remediation are excellent supplements to pharmacotherapy.

REFERENCES

[web] Fountoulakis KN et al (2010). The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 3: The Clinical Guidelines, Int Journal of Neuropsychopharmacology, Volume 20, Issue 2, 1 February 2017, Pages 180–195

[PDF] Grande I, Berk M, Birmaher B, Vieta E (2016). Bipolar disorder, The Lancet, Volume 387, Issue 10027, 1561 - 1572