Medications for Bipolar Disorder

This chapter reviews current evidence for medications in the treatment of patients with bipolar disorder. It will overview the historic “mood stabilizers” such as lithium, valproate, and carbamazepine, and also lamotrigine and the medications for psychosis (antipsychotics). This pragmatic approach is cognizant of the major shift in prescribing patterns for bipolar disorder which has occurred internationally over the last two decades, with a dramatic increase in the use of medications for psychosis for this condition. A wide range of treatments have now been shown to be effective for the acute treatment of mania, with it now evident that medications for psychosis are to be preferred in the short-term control of this urgent presentation. Bipolar depression remains a therapeutic challenge and remains an area in urgent need of new and more effective treatments. Maintenance therapy is critical in view of the high rates of relapse and disability with this condition. While lithium remains the gold standard treatment option for prevention of mania, lamotrigine has been shown to be effective in preventing depressive recurrences. Further, many of the dopamine serotonin blockers (atypical antipsychotics) have also been found to be useful, particularly for manic relapse, with long-acting injectables having a demonstrable advantage. Finally, growing evidence is confirming that optimal treatment comprises effective mood-stabilizing pharmacotherapy concurrent with evidence-based psychological therapies.