Pharmacological treatment of bipolar disorder

Abstract Bipolar affective disorder, classically characterized by repeated episodes of mania interspersed with periods of depression, is a serious mental illness associated with significant morbidity and mortality. Management is aimed at both the rapid treatment of acute episodes and long-term prophylaxis. There continues to be a lack of good-quality research available on which to base treatment regimens, particularly with regard to long-term management, rapid cycling, optimal treatment of bipolar depression and the use of antidepressants, and in the efficacy and safety of drug combinations. Lithium continues to be advocated as a first-line treatment, particularly in long-term therapy. Over recent years the anticonvulsant valproate has joined lithium as an alternative first-line therapy, despite what some would argue as a relative dearth in conclusive evidence. There is also growing evidence for the use of lamotrigine and atypical antipsychotics, particularly olanzapine, not only in the treatment of acute manic and mixed relapses but also as prophylactic therapy. Management of bipolar affective disorder needs to be tailored to the individual, with psychoeducation, psychological and social interventions included in a comprehensive package of care, along with pharmacological treatments.