[Status of thymoleptics in the treatment of bipolar disorders]

The widening of the concept of bipolar disorders to embrace the notion of a "spectrum" of disorders leads to the supposition that almost 5% of the general population may affected. Thymoleptics are the key treatment, but they should be prescribed over many years, and it is necessary to determine the threshold above which treatment should be considered. Lithium salts remain the reference thymoleptic treatment, but they are insufficiently effective in 30 to 60% of patients. They have a narrow therapeutic margin and are frequently accompanied by adverse effects. Numerous studies, mainly open, have confirmed the value of anti-epileptic thymoleptics (carbamazepine and valpromide) in mood disorders. They are comparable in efficacy to lithium salts, both in first-time treatment and in prophylactic use. Their main indications are as follows: marked progression of the mood disorder with the presence of mixed disorders or rapid-cycling disorders, concomitant organic pathology, substance abuse or personality disorder, poor response to lithium salts.