Alternatives to lithium therapy in the treatment of acute mania

Manic depressive illness is a poorly understood condition whose causes are primary (possibly hereditary) as well as secondary. It is difficult to diagnose and treat and at the present time, lithium and anticonvulsants remain the preferred medications for the acute phase of mania. However, concomitant use of benzodiazepines or neuroleptics may be helpful to facilitate early response to treatment. Management of lithium refractory patients unresponsive to reasonable trials of anticonvulsants may make it necessary for the psychiatrist to use electroconvulsive therapy, generally considered a safe and effective alternative. Evaluation of concurrent illnesses and recognition of side effects in these treatments are also important to optimize results.