Treatment in Bipolar Disorder

Patients with bipolar disorder require hfelong prophylaxis with a mood stabhizer, both to prevent new episodes and to decrease the likelihood that the hlness will become more severe. Ninety percent 

American Psychiatric Association Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry 159 (4 suppl) 1-50, 2002 

Arana GW, Epstein S, Molloy M, et al Carhamazepine-induced reduction of plasma alprazolam concentrations a clinical case report. J Clin Psychiatry 49 448-449, 1988 

Bertollini R, Kallen B, Mastroiacovo P, et al Anticonvulsant drugs in monotherapy effect on fems. Eur J Epidemiol 3 164—171, 1987 

Bowden CL, Janicak PG, Orsulak P, et al Relation of serum valproate concentration to response in mania. Am J Psychiatry 153 765—770, 1996 

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Goodwin FK, Goldstein MA. Optimizing lithium treatment in bipolar disorder a review of the literature and clinical recommendations. J Psychiatr Pract 2003 9(5) 333-343. 

Suppes, T., Baldessarini, R.J., Faedda, G.L., and Tohen, M. (1991) Risk of recurrence following discontinuation of lithium treatment in bipolar disorder. Arch Gen Psychiatry 48 1082—1088. 

Faedda GL, Tondo L, Baldessarini RJ, et al Outcome after rapid vs. gradual discontinuation of lithium treatment in bipolar disorders. Arch Gen Psychiatry 50 448-455, 1993... 

Vieta E, Sanchez-Moreno J, Goikolea JM, Colom F, Martinez-Aran A, Benabarre A, Corbella B, Torrent C, Comes M, Reinares M, Brugue E. Effects of weight and outcome of long-term olanzapine-topiramate combination treatment in bipolar disorder. J Clin Psychopharmacol 2004 24 374-8. 

Baldessarini, R. J., Tondo, L., St Viguera, A. C. 1999, Discontinuing lithium maintenance treatment in bipolar disorders risks and implications, Bipolar.Disord., vol. 1, no. 1, pp. 17-24. 

Reduces symptoms of acute psychotic mania but not proven as a mood stabilizer or as an ettective maintenance treatment in bipolar disorder... 

Antipsychotic drugs commonly have been used empirically to manage manic and psychotic illness in bipolar disorder patients. Indeed, standard neuroleptics are a mainstay of the treatment of acute mania (only chlorpromazine is FDA-approved for this indication, although haloperidol has also been widely used) and for manic episodes that break through prophylactic treatment with LF or an anticonvulsant. However, the older antipsychotics are not used routinely for long-term prophylactic treatment in bipolar disorder because their effectiveness is untested, some may worsen depression, and the risk of tardive dyskinesia in these syndromes may be higher than in schizophrenia. 

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