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Bipolar disorder: Treatment

Pharmacotherapy

  • Acute mania can be treated with lithium, divalproex, carbamazepine, lamotrigine or second-generation antipsychotics.
  • The usefulness of antidepressants for treating bipolar disorder is controversial because there is a risk of cycling or mania. This means that antidepressants should not be administered unless a mood stabilizer is also used.
  • To prevent recurrence of bipolar symptoms, long-term treatments include lithium, valproic acid and carbamazepine.
  • Lamotrigine has prophylactic antidepressant and mood-stabilizing properties.

Psychotherapy

Structured psychological interventions:

  • cognitive-behavioural therapy (CBT) 
  • interpersonal therapy (IPT),

Education and support

Provide:

  • advice and information about the importance of sleep hygiene and a regular lifestyle
  • information about bipolar disorder, symptoms of relapse, and treatment options

Patients and their families may benefit from formal psychoeducation of family support and education groups.

Evidence summary

Abraham, G. (2012). Mood disorders. In A. Khenti, J. Sapag, S. Mohamoud & A. Ravindran (Eds.), Collaborative Mental Health: An Advanced Manual for Primary Care Professionals (pp. 87–114). Toronto, ON: Centre for Addiction and Mental Health.

National Institute for Health and Clinical Excellence (2006). Bipolar Disorder Quick Reference Guide. London, UK: Author

 


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