psychiatric disorders
Medications for Treatment of Bipolar Disorders
Medication Selection and Use
Choice of pharmacologic agents to treat Bipolar Disorders can be difficult because all medications can potentially have significant adverse effects, drug interactions are common, and no medication is universally effective. Selection should be based on what has previously been effective and well-tolerated in a given patient. If there is no prior experience (or it is unknown), choice is based on the patient’s medical history (in relation to the adverse effects of the specific mood stabilizer) and the severity of symptoms. (See also Bipolar Disorders .) in which immediate patient safety and management is compromised, urgent behavioral control usually requires a sedating Second-generation antipsychotics , sometimes supplemented initially with a benzodiazepine such as Forless severe acute episodesin patients without contraindications (eg, renal disorders),lithiumis a good first choice for both mania and depressive episodes. Because its onset is slow (4 to 10 days), patients with significant symptoms may also be given an antiseizure medication or a second-generation antipsychotic. ( Medication selection and use references ). Once remission is achieved, preventive treatment with mood stabilizers is indicated for all patients with bipolar I disorder (bipolar I is defined by the presence of at least one full-fledged manic episode). If episodes recur during maintenance treatment, clinicians should determine whether adherence is poor and, if so, whether nonadherence preceded or followed recurrence. Reasons for nonadherence should be explored to determine whether a change in mood stabilizer type or dosing would render treatment more acceptable. 1.Bobo WV: The diagnosis and management of bipolar I and II disorders: Clinical practice update.Mayo Clin Proc92(10):1532-1551, 2017. doi: 10.1016/j.mayocp.2017.06.022 2.Calabrese JR, Durgam S, Satlin A, et al: Efficacy and safety oflumateperonefor major depressive episodes associated with bipolar I or bipolar II disorder: A phase 3 randomized placebo-controlled trial.Am J Psychiatry178(12):1098-1106, 2021. doi: 10.1176/appi.ajp.2021.20091339 