Condition

Bipolar Disorder

Mood disorder with manic and depressive episodes

40M
People Affected
25
Active Trials
800K
New Cases/Year
10K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Quetiapine
88% Effectiveness• 90% Confidence• 40% Safety• 120 trials• 40K participants
HIGH EvidenceGood ValueDose: 50-800mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
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40
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

lifetime

Response Rate

65%

Remission Rate

40%

Number Needed to Treat (NNT)

7

Number Needed to Harm (NNH)

7

Common Side Effects:

Sedation/Somnolence: 60%
Weight gain: 35%
Dry mouth: 20%
Dizziness: 15%
Metabolic changes (cholesterol, glucose): 15%

Annual Cost of Care

Drug Cost

$600

Monitoring

$1,000

Side Effects

$400

Total Annual

$2,000

Cost-Effectiveness

GOOD

QALYs Gained

0.6

ICER

$60,000/QALY

Cost per Remission

$5,000

Cost per Responder

$3,076.9

Treatment Outcomes
Primary Outcomes
Young Mania Rating Scale (YMRS) score28/60 points (moderate-severe mania)
-36% (-10 points)
Montgomery-Åsberg Depression Rating Scale (MADRS) score28/60 points (moderate-severe depression)
-36% (-10 points)
Clinical Global Impression - Severity (CGI-S) score4.5/7 points (moderately ill)
-27% (-1.2 points)
Secondary Benefits
Global Assessment of Functioning (GAF) score55/100 points (serious symptoms)
+15% (+8 points)
Pittsburgh Sleep Quality Index (PSQI) score16/21 points (poor sleep quality)
-25% (-4 points)
Body Weight70 kg
+5% (+3.5 kg)
Common Side Effects
Sedation/Somnolence
+60%
Weight gain
+35%
Dry mouth
+20%

Clinical Trial Phases:

Phase 4
2
Olanzapine
87% Effectiveness• 90% Confidence• 40% Safety• 84 trials• 25K participants
HIGH EvidenceGood ValueDose: 5-20mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
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40
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

lifetime

Response Rate

65%

Remission Rate

45%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

5

Common Side Effects:

Weight gain: 50%
Sedation: 40%
Dry mouth: 15%
Metabolic syndrome: 25%

Annual Cost of Care

Drug Cost

$500

Monitoring

$1,100

Side Effects

$600

Total Annual

$2,200

Cost-Effectiveness

GOOD

QALYs Gained

0.7

ICER

$70,000/QALY

Cost per Remission

$4,888.9

Cost per Responder

$3,384.6

Treatment Outcomes
Primary Outcomes
Young Mania Rating Scale (YMRS) Score28 points (range 0-60)
-45% (-12.6 points)
Montgomery-Åsberg Depression Rating Scale (MADRS) Score27 points (range 0-60)
-40% (-10.8 points)
Clinical Global Impression - Severity (CGI-S) Score4.5 points (range 1-7)
-33.3% (-1.5 points)
Secondary Benefits
Global Assessment of Functioning (GAF) Score50 points (range 0-100)
+18% (+9 points)
Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) Score40 points (range 0-100)
+15% (+6 points)
Insomnia Severity Index (ISI) Score18 points (range 0-28)
-30% (-5.4 points)
Common Side Effects
Weight gain
+50%
Sedation
+40%
Dry mouth
+15%

Clinical Trial Phases:

Phase 4
3
Lurasidone
86% Effectiveness• 85% Confidence• 55% Safety• 31 trials• 10K participants
HIGH EvidenceModerate ValueDose: 20-120mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
55
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

lifetime

Response Rate

60%

Remission Rate

40%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

15

Common Side Effects:

Akathisia: 15%
Nausea: 12%
Somnolence: 12%
Parkinsonism: 7%
Weight gain: 5%

Annual Cost of Care

Drug Cost

$15,000

Monitoring

$900

Side Effects

$200

Total Annual

$16,100

Cost-Effectiveness

MODERATE

QALYs Gained

0.65

ICER

$90,000/QALY

Cost per Remission

$40,250

Cost per Responder

$26,833.3

Treatment Outcomes
Primary Outcomes
MADRS Total Score32/60 points
-37.5% (-12 points)
Y-MRS Total Score20/60 points
-30% (-6 points)
CGI-S Score4.5/7 points
-26.7% (-1.2 points)
Secondary Benefits
Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) Score40/100 points
+37.5% (+15 points)
Functioning Assessment Short Test (FAST) Score40/72 points
-30% (-12 points)
Hamilton Anxiety Rating Scale (HAM-A) Total Score20/56 points
-30% (-6 points)
Common Side Effects
Akathisia
+15%
Nausea
+12%
Somnolence
+12%

Clinical Trial Phases:

Phase 4
4
Lithium
85% Effectiveness• 95% Confidence• 30% Safety• 156 trials• 50K participants
HIGH EvidenceExcellent ValueDose: 600-1800mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
30
DangerousModerateSafe

Time to Effect

1-4 weeks

Duration

lifetime

Response Rate

65%

Remission Rate

45%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

15

Common Side Effects:

Tremor: 40%
Polyuria/Polydipsia: 55%
Weight gain: 25%
Hypothyroidism: 15%
Renal impairment: 15%

Annual Cost of Care

Drug Cost

$150

Monitoring

$1,100

Side Effects

$300

Total Annual

$1,550

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.8

ICER

$30,000/QALY

Cost per Remission

$3,444.4

Cost per Responder

$2,384.6

Treatment Outcomes
Primary Outcomes
Mania Symptom Severity (YMRS)YMRS score: 28/60 (moderate to severe mania)
-45% (-12.6 points)
Depression Symptom Severity (MADRS)MADRS score: 25/60 (moderate depression)
-40% (-10.0 points)
Mood Episode Recurrence Rate2.5 episodes per year (untreated/placebo)
-50% (-1.25 episodes per year)
Secondary Benefits
Suicide Attempt Relative RiskRelative Risk (RR): 1.0 (vs. placebo)
-70% (-0.7 RR)
Quality of Life (Q-LES-Q)Q-LES-Q score: 50/100
+30% (+15.0 points)
Hospitalization Rate for Mood Episodes0.5 hospitalizations per year (untreated/placebo)
-40% (-0.2 hospitalizations per year)
Common Side Effects
Tremor
+40%
Polyuria/Polydipsia
+55%
Weight gain
+25%

Clinical Trial Phases:

Phase 4
5
Aripiprazole
85% Effectiveness• 88% Confidence• 50% Safety• 81 trials• 20K participants
HIGH EvidenceGood ValueDose: 10-30mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
50
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

lifetime

Response Rate

60%

Remission Rate

35%

Number Needed to Treat (NNT)

9

Number Needed to Harm (NNH)

12

Common Side Effects:

Akathisia: 20%
Nausea: 12%
Insomnia: 12%
Weight gain: 10%

Annual Cost of Care

Drug Cost

$800

Monitoring

$900

Side Effects

$200

Total Annual

$1,900

Cost-Effectiveness

GOOD

QALYs Gained

0.6

ICER

$55,000/QALY

Cost per Remission

$5,428.6

Cost per Responder

$3,166.7

Treatment Outcomes
Primary Outcomes
Young Mania Rating Scale (YMRS) score28/60 (severe mania)
-42.86% (-12 points)
Clinical Global Impression - Severity (CGI-S) - Bipolar Mania4.5/7 (markedly ill)
-44.44% (-2 points)
Global Assessment of Functioning (GAF) score45/100 (serious impairment)
+44.44% (+20 points)
Montgomery-Åsberg Depression Rating Scale (MADRS) score27/60 (moderate depression)
-29.63% (-8 points)
Secondary Benefits
Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) score45/100 (poor quality of life)
+33.33% (+15 points)
Pittsburgh Sleep Quality Index (PSQI) score15/21 (poor sleep quality)
-33.33% (-5 points)
Common Side Effects
Akathisia
+20%
Nausea
+12%
Insomnia
+12%

Clinical Trial Phases:

Phase 4
6
Valproate (Divalproex)
82% Effectiveness• 90% Confidence• 35% Safety• 120 trials• 40K participants
HIGH EvidenceExcellent ValueDose: 750-2500mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
35
DangerousModerateSafe

Time to Effect

1-3 weeks

Duration

lifetime

Response Rate

65%

Remission Rate

40%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

15

Common Side Effects:

Nausea/vomiting: 25%
Weight gain: 30%
Tremor: 15%
Hair loss: 15%
Liver dysfunction: 7%
Teratogenicity: 7%

Annual Cost of Care

Drug Cost

$300

Monitoring

$1,000

Side Effects

$300

Total Annual

$1,600

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.7

ICER

$45,000/QALY

Cost per Remission

$4,000

Cost per Responder

$2,461.5

Treatment Outcomes
Primary Outcomes
Young Mania Rating Scale (YMRS) ScoreYMRS score: 29/60
-45% (-13 points)
Clinical Global Impression - Severity (CGI-S) ScoreCGI-S score: 5.5/7
-25% (-1.4 points)
Agitation Score (derived from validated scales)Agitation score: 8/12
-35% (-2.8 points)
Secondary Benefits
Global Assessment of Functioning (GAF) ScoreGAF score: 35/100
+18% (+6 points)
Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) ScoreQ-LES-Q-SF score: 40/100
+15% (+6 points)
Insomnia Severity Index (ISI) ScoreISI score: 20/28
-25% (-5 points)
Common Side Effects
Nausea/vomiting
+25%
Weight gain
+30%
Tremor
+15%

Clinical Trial Phases:

Phase 4
7
Lamotrigine
80% Effectiveness• 90% Confidence• 60% Safety• 65 trials• 30K participants
HIGH EvidenceExcellent ValueDose: 100-400mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

8-12 weeks (after titration)

Duration

lifetime

Response Rate

50%

Remission Rate

30%

Number Needed to Treat (NNT)

10

Number Needed to Harm (NNH)

1000

Common Side Effects:

Headache: 25%
Nausea: 15%
Dizziness: 17%
Rash (benign): 10%
Stevens-Johnson Syndrome (SJS)/TEN: 0.1%

Annual Cost of Care

Drug Cost

$200

Monitoring

$800

Side Effects

$100

Total Annual

$1,100

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.5

ICER

$40,000/QALY

Cost per Remission

$3,666.7

Cost per Responder

$2,200

Treatment Outcomes
Primary Outcomes
MADRS score (Depression Severity)28 points (Scale: 0-60)
-40% (-11.2 points)
CGI-BP Severity score (Overall Illness)4.5 points (Scale: 1-7, 'moderately ill')
-27% (-1.2 points)
YMRS score (Mania Severity)15 points (Scale: 0-60, 'mild to moderate mania/hypomania')
-10% (-1.5 points)
Secondary Benefits
Q-LES-Q total score (Quality of Life)50 points (Scale: 0-100)
+20% (+10 points)
HAM-A score (Anxiety Severity)20 points (Scale: 0-56, 'moderate anxiety')
-25% (-5 points)
Global Assessment of Functioning (GAF) score60 points (Scale: 0-100, 'moderate symptoms or moderate difficulty in social, occupational, or school functioning')
+20% (+12 points)
Common Side Effects
Headache
+25%
Nausea
+15%
Dizziness
+17%

Clinical Trial Phases:

Phase 4