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