Chronic neuroleptic use in manic-depressive illness

Although chronic use of neuroleptic medications is generally discouraged in patients with manic-depressive illness, review of the limited data available suggests that such use may be extensive. Evidence for the efficacy, risks, and determinants of chronic neuroleptic use in bipolar patients is also reviewed. Research strategies designed to reduce chronic use are discussed. These include defining the risks of neuroleptic taper after acute use of neuroleptic-lithium combinations, reducing acute neuroleptic use, and randomly assigning lithium-refractory, neuroleptic-maintained patients to comparisons with alternatives such as carbamazepine, valproic acid, or clonazepam.