An ever-increasing pharmacopoeia for the management of patients with bipolar disorder

Bipolar disorder is a recurrent and relapsing mood disorder characterized by cycles of depression and mania. This article addresses the treatment of patients with bipolar mania, which remains one of the most difficult challenges facing clinicians. Patients require safe and effective therapeutic approaches for acute episodes of mania and depression, as well as chronic prophylaxis against future episodes. Monotherapeutic approaches are rarely effective, and combination approaches are associated with an increased risk of adverse events. Lithium is the only agent currently approved for the treatment of both acute episodes of mania and maintenance therapy; however, it is associated with a relatively poor response rate, high relapse rate, and less-than-optimal side effect profile. Other recent approaches have included several anticonvulsant agents, as well as conventional and atypical antipsychotic agents.