Treatment of bipolar disorder

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6.03.5.3.1.1 Acute mania

Lithium is generally the drug of choice to stabilize the person and is usually very effective in controlling mania and preventing new episodes. Response to lithium treatment may take several days initially. If the individual is experiencing psychotic symptoms, antipsychotic medications, e.g., clozapine, olanzapine, and other atypical antipsychotic agents, may be prescribed.

Mood-stabilizing anticonvulsant drugs, such as valproate (42), lamotrigine (43), carbamazepine (44), oxcarbazepine (45), and topiramate (46), may also be used. Often these medications are combined with lithium for maximum effect with mixed benefit to the patient.

6.03.5.3.1.2 Acute depression

Lithium can be a very effective treatment for the depression that occurs in bipolar disorder. Antidepressants, including SSRIs, may also be prescribed. Antidepressant medications used to treat the depressive symptoms of bipolar disorder, when taken without a mood-stabilizing medication, can increase the risk of switching into mania or hypomania, or developing rapid cycling, in people with bipolar disorder. Therefore, mood-stabilizing medications are generally required, alone or in combination with antidepressants, to protect patients with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today.

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