Clonazepam in acute and maintenance treatment of bipolar affective disorder

This is a report on the efficacy of clonazepam in the treatment of acute mania. The advantages of clonazepam over standard neuroleptics are its rapidity of action, its lack of toxicity, and, particularly important, the fact that it does not cause tardive dyskinesia, a potentially disabling neurological side effect of neuroleptic treatment. Results are reported of double-blind, controlled studies comparing clonazepam with lithium and with haloperidol in the treatment of acutely manic patients who were newly admitted through an emergency room. For the maintenance treatment of patients with bipolar illness, a combined approach is outlined that involves medications with different mechanisms of action. Treatment is initiated with lithium, and, if necessary, tryptophan is added to enhance lithium response; drug-resistant patients who fail to respond satisfactorily to lithium or lithium plus tryptophan are given adjunctive clonazepam therapy.