Bipolar disorder requires lifelong treatment with medication, even during periods when you feel better. People who skip maintenance treatment are at high risk of relapse of symptoms or minor mood swings turning into full-blown mania or depression. Treatment for bipolar disorder aims to reduce the severity and number of episodes of depression and mania to allow for the most normal life possible. Pioneering lithium and chlorpromazine trials were conducted in the 1970s and were followed by a focus on antiepileptics (e.g., valproate and carbamazepine) in the 1980s and 1990s.
There are few trials that directly evaluate the comparative efficacy of different second-generation antipsychotics, but a meta-analysis of mixed treatments compared 13 drugs studied in 68 randomized controlled trials (16,073 participants). Antipsychotic drugs appear to be better than anticonvulsants and lithium in the treatment of manic episodes. Olanzapine, risperidone and haloperidol appear to have the best profile of currently available agents (Figure). Most of the time, bipolar disorder develops or begins in late adolescence (adolescent years) or early adulthood.
Occasionally, bipolar symptoms may occur in children. While symptoms come and go, bipolar disorder usually requires lifelong treatment and doesn't go away on its own. Bipolar disorder can be a major factor in suicide, job loss, and family discord, but proper treatment leads to better outcomes. We 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, whether pharmacological or psychological, have been based on an extension of the use of another disorder, for example, antipsychotics in 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; 4,5,7 these figures probably underestimate the proportion of patients with depression resistant to treatment in clinical practice. The best treatment for bipolar disorders is a combination of medications and psychotherapy tailored to the individual. If an antidepressant is not clearly having a beneficial effect for bipolar depression, there is usually little reason to continue it.
Advances in pharmacological treatment of bipolar disorder stem primarily from the reuse of drugs used in other neuropsychiatric disorders, and do not address the mood instability that characterizes the disorder. Caregiver education about bipolar disorder could translate into benefits for patients, even if patients don't attend educational sessions. 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 related to bipolar disorder, including depression, suicidal thoughts, and irritability.
The most commonly used drugs for the treatment of bipolar disorder are lithium carbonate and valproic acid (also known as Depakote or generically as divalproex). While researchers found that medical cannabis use offered partial, short-term relief from clinical symptoms15, another case study showed that treating two bipolar type I patients with CBD had no impact on manic symptoms. One of the main problems is that the risks of taking bipolar medications during pregnancy are not well understood. .
