Bipolar Disorder-Treatment


Bipolar Disorder-Treatment


Pharmacological treatment of bipolar disorder:

1. Mood Stabilizers

  • Lithium, Valproate, Carbamazepine, Oxacarbamazepine and Lamotrigine
  • Lithium – Prototypical mood stabilizer. Takes 1-2 weeks to start acting
  • Valproate – Preferred Drug for acute mania
  • Lamotrigine – Used in Acute depressive episode of bipolar disease [Bipolar Depression]

2. Antipsychotics

3. Benzodiazepines

  • High potency BDZ used for their calming effects [ Lorazepam and clonazepam]

4. Antidepressants

• NEVER USED ALONE in bipolar disease

Treatment guidelines used in bipolar disorders:

Acute Mania / Mixed Episode:

  • Severe Cases – Initiate Lithium in combination with valproate and or antipsychotic
  • Less Severe cases – Monotherapy with Lithium or valproate or atypical antipsychotic started
  • Short term BDZ also used.
  • For Mixed episodes valproate preferred over lithium

Acute Depression:

  • Initiate Lithium or Lamotrigine. In Severe case Lithium + Antidepressants
  • Quetiapine alone or with olanzapine and fluoxetine
  • ECT if suicide risk

Maintenance:

  • Lithium and Valproate used for at least 2 years especially if 2 or more acute attack in Bipolar I illness

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