Psychopharmacologic Treatment Strategies for Depression, Bipolar Disorder, and Schizophrenia

2 January 2001 | Volume 134 Issue 1 | Pages 47-60

Patients with serious psychiatric disorders are frequently treated by primary care physicians, who may have difficulty keeping up with recent advances in psychiatry. This paper presents an updated synopsis for three major psychiatric illnesses: major depression, bipolar disorder, and schizophrenia. Current definitions, updated diagnostic criteria, short- and long-term treatment strategies with algorithms, and special challenges for the clinician are discussed for each of these illnesses. On the basis of each illness's distinct characteristics, five treatment principles are emphasized: 1) Treatment strategies should be long-term and should emphasize adherence, 2) treatment choice should be empirical, 3) combinations of medications may be helpful, 4) a combination of psychosocial and pharmacologic treatments may be more useful than either alone, and 5) the family or "significant others" as well as a consumer organization need to be involved. Some of the new directions in clinical research to refine these strategies and meet these challenges are also described.

Author and Article Information

From Stanford University School of Medicine, Stanford, California; University of Texas Southwestern Medical Center, Dallas, Texas; and University of California, Los Angeles, Los Angeles, California.

Grant Support: The authors have received financial and/or research funding support from various sources, including the following manufacturers of drugs that may be discussed in this manuscript: Abbott Laboratories, Zeneca, Eli Lilly, Pfizer, Janssen, Novartis, SmithKline Beecham, Parke-Davis, Glaxo Wellcome, Bristol-Meyers Squibb, Forrest Laboratories, Scios, Wyeth-Ayerst, Organon, and Pharmacia Upjohn.

Requests for Single Reprints: Ira D. Glick, MD, Stanford University School of Medicine, 401 Quarry Road, Suite 2122, Stanford, CA 94305-5723; e-mail, iraglick{at}stanford.edu.

Current Author Addresses: Dr. Glick: Stanford University School of Medicine, 401 Quarry Road, Suite 2122, Stanford, CA 94305-5723.

Dr. Suppes: Bipolar Disorder Clinic, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9070.

Dr. DeBattista: Stanford University School of Medicine, 401 Quarry Road, Suite 2137, Stanford, CA 94305.

Dr. Hu: Stanford University School of Medicine, 401 Quarry Road, Suite 2114, Stanford, CA 94305.

Dr. Marder: West Los Angeles Veterans Affairs Medical Center, MIRECC 210A, 11301 Wilshire Boulevard, Los Angeles, CA 90072-1003.