Objective
Bipolar Disorders (BD) have large personal, social and economic repercussions. For this reason, cheap and effective treatments for bipolar patients using the Public Health System (PHS) are needed. With this aim, algorithms for the treatment of BD using only medications provided by the Brazilian PHS were proposed in a Mood Disorders Program (PROPESTH) at Hospital Psiquiátrico São Pedro in Porto Alegre, Brazil.
Methods
The algorithms from PROPESTH (The BREATH Study) were developed through a critical review of the available literature. These ranged from expert algorithms (such as CANMAT) to recognized studies such as STEP-BD, and adapted to the Brazilian PHS. Each of the guidelines was obtained after consensus by a board of PROPESTH team of experts in BD.
Results
The algorithms include drugs provided by PHS and are based on a) Step 1: Monotherapy, b) Step 2: An association of drugs, c) Further Steps: A change of drugs in different associations d) Finally: High cost drugs exclusively for refractory cases.
The selected drugs are lithium; typical antiepileptic agents (carbamazepine and valproate); SSRI (sertraline); TCA (nortriptyline); an atypical antipsychotic (risperidone); and lamotrigine exclusively for refractory cases. The step switching is determined by the grade of response evaluated by different scales (YMRS, Bech Rafaelsen, Altmann, HAM-D, MADRS).
Conclusions
The algorithms from PROPESTH (The BREATH Study) were designed to be an alternative in the treatment of BD in the public health system for developing countries as Brazil, using low cost medications which are conjectured to prove a good cost-effectiveness relation.