Pharmacotherapy in bipolar disorder
by
Nolen WA
Universitair Medisch Centrum Utrecht
H.C.Rumkegroep, Willem Arntsz Huis.
Ned Tijdschr Geneeskd 1999 Jun 19; 143(25):1299-305

ABSTRACT

In the treatment of manic depressive disorders a distinction is made between acute treatment (combating the mania and the depression) and the maintenance treatment (prevention of subsequent episodes). In both forms of therapy the mood stabilizers are crucial: lithium carbonate, the anticonvulsants carbamazepine and valproic acid. The efficacy of lithium carbonate has been demonstrated in the acute treatment of mania and depression as well as in the maintenance treatment. Carbamazepine may be regarded as a good alternative, especially for the acute treatment of mania and for the maintenance treatment. Valproic acid so far has only be demonstrated to be efficacious in the acute treatment of mania. Monotherapy with a mood stabilizer is a first option, but its insufficient efficacy in many patients nevertheless necessitates a combined treatment, with two or even three mood stabilizers or with a mood stabilizer and other psychoactive agents. In the acute treatment of mania, antipsychotics are indicated in case of a severe or psychotic mania and benzodiazepines in severe disorders of sleep or restlessness. Antidepressants have a role as comedication in the acute treatment of the bipolar depression.

Mania
Options
Lithium
Valproate
Gabapentin
Lamotrigine
Cyclothymia
Carbamazepine
Bipolar disorders
Bipolar depression
Bipolar versus unipolar
Social phobia and bipolarity
Bipolar treatment guidelines
Melancholic bipolar depression
Bipolar depression: undertreatment
Mood stabilisers: common mechanism?
Omega 3 fatty acids in bipolar disorder
Relationship of major depressive disorder to bipolar disorder

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