NICE guidance: Why not clozapine for treatment-refractory bipolar disorder? - Authors' reply

Abstract

Comments on an article by Tarun Bastiampillai et al. (see record 2016-28928-015). Tarun Bastiampillai and colleagues for their Correspondence. There is no consensus on the definition of "treatment-resistant bipolar disorder". Some people who failed to respond to previous therapies were included in trials we considered in the UK National Institute for Health and Care Excellence (NICE) guideline. We did not exclude trials that included only people who failed to respond to previous treatments. It is unclear whether Bastiampillai and colleagues advocate the use of clozapine for the treatment of particular bipolar disorder episodes (ie, mania or depression) or for long term management, which were considered separately in the guideline. There are randomized controlled trials of treatments for all phases of bipolar disorder, and the NICE guideline recommends the treatments supported by rigorous evidence of effectiveness and safety. NICE has recommended clozapine for treatment-resistant schizophrenia in the psychosis and schizophrenia guideline. (PsycINFO Database Record (c) 2016 APA, all rights reserved)