Mania treatment guidelines

Treatment of depressive episodes in bipolar disorder patients presents a particular challenge because of the risk of a pharmacologic mood switch to mania, although there is not complete agreement about such risk. Treatment guidelines suggest lithium or lamotrigine as first-line therapy.17,41 Olanzapine has also demonstrated efficacy in treatment of bipolar depression, and quetiapine is under review for approval of treatment of bipolar depression.42 When these fail, efficacy data support use of antidepressants. 

Some patients with bipolar disorder will need antidepressants. Although the switch rate into mania or induction of rapid cychng by antidepressants is controversial, these agents do appear to present a risk for some patients, often with devastating consequences. Therefore, when a patient with bipolar disorder is prescribed an antidepressant, it should only be in combination with a medication that has established antimanic properties. Controlled comparative data on the use of specific antidepressant drugs in the treatment of bipolar depression are sparse. Current treatment guidelines extrapolate from these few studies and rely heavily on anecdotal chnical experience. Overah, tricyclic antidepressants should be avoided when other viable treatment options exist. Electroconvulsive therapy should be considered in severe cases. 

Some evidence of effectiveness in treating acute mania inciuded in American Psychiatric Association s bipoiar treatment guidelines as an option for acute treatment and maintenance treatment of bipoiar disorder... 

In the UK the National Institute for Clinical Excellence (NICE) has given guidance supporting the use of olanzapine and valproate semisodium in acute mania. NICE guidelines on the treatment of bipolar disorder are expected in June 2006. 

Published Guidelines and Treatment Protocols. Currently there are no published evidence-based studies that compare different agents and combination therapies for the treatment of acute mania, mixed... 

Use alone or in combination with other drugs (e.g., lithium, valproate, antipsychotics) for the acute and long-term maintenance treatment of mania or mixed episodes for bipolar I disorder. APA guidelines recommend reserving it for patients unable to tolerate or who have inadequate response to lithium or valproate. 

Grunze H, Kasper S, Goodwin G, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders, Part II Treatment of Mania. World J Biol Psychiatry 2003 4 5-13. 

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