Bipolar disorder is a lifelong condition that requires ongoing treatment, even during periods of remission. Without proper maintenance, minor mood swings can quickly escalate into full-blown mania or depression. The goal of treatment for bipolar disorder is to reduce the severity and frequency of episodes, allowing the individual to lead as normal a life as possible. In the 1970s, pioneering trials of lithium and chlorpromazine paved the way for further research into antiepileptics such as valproate and carbamazepine in the 1980s and 1990s.
While there are few studies that directly compare the efficacy of different second-generation antipsychotics, a meta-analysis of mixed treatments involving 68 randomized controlled trials (16,073 participants) found that antipsychotic drugs were more effective than anticonvulsants and lithium in treating manic episodes. Olanzapine, risperidone and haloperidol were identified as having the best profiles among currently available agents (Figure). Bipolar disorder typically develops in late adolescence or early adulthood, although it can sometimes occur in children. It is a chronic condition that requires lifelong treatment and cannot be cured.
If left untreated, bipolar disorder can lead to job loss, family discord and even suicide. However, with proper treatment, individuals can lead healthy and productive lives. In this article, we will review recent developments in the acute and long-term treatment of bipolar disorder and identify promising future routes for therapeutic innovation. Most recently introduced treatments for bipolar disorder have been based on existing treatments for other disorders, such as antipsychotics for mania and antidepressants or cognitive behavioral therapy for bipolar depression.
Up to a third of patients with bipolar disorder do not respond to treatments in naturalistic studies; these figures likely underestimate the proportion of patients with depression resistant to treatment in clinical practice. The best approach to treating bipolar disorder is a combination of medications and psychotherapy tailored to the individual's needs. If an antidepressant does not appear to be having a beneficial effect on bipolar depression, there is usually no reason to continue it. Advances in pharmacological treatment of bipolar disorder have largely been based on repurposing drugs used for other neuropsychiatric disorders, without addressing the underlying mood instability that characterizes the disorder.
Caregiver education about bipolar disorder could also have positive benefits for patients, even if they do not attend educational sessions themselves. In the UK, lithium and the antipsychotic drug aripiprazole are currently the only drugs officially approved for use in adolescents with bipolar disorder. Dysphoric mania is a common group of symptoms associated with bipolar disorder, including depression, suicidal thoughts and irritability. Lithium carbonate and valproic acid (also known as Depakote or divalproex) are the most commonly used drugs for treating bipolar disorder. While some research has suggested that medical cannabis may offer partial relief from symptoms in the short term, another case study found that treating two bipolar type I patients with CBD had no impact on manic symptoms. One major issue is that the risks associated with taking bipolar medications during pregnancy are not well understood.
In conclusion, while there is still much work to be done in terms of understanding and treating bipolar disorder, recent developments have provided promising new avenues for therapeutic innovation.