BIPOLAR DISORDER - A PRACTICAL GUIDE TO DRUG-TREATMENT

Bipolar affective disorder is a recurrent, long term mood disorder cha racterised by the presence of both depressive and manic phases. It inv olves substantial morbidity with a high suicide risk, and frequently c auses a variety of psychological and social problems. The primary goal s in the management of patients with bipolar disorder are the treatmen t of acute depressive and manic episodes and the prevention of future affective episodes. Other equally important goals are interepisodic mo od stabilisation and the reduction of excess mortality, mostly caused by suicide. Long term treatment of bipolar disorder requires the devel opment of an overall psychiatric management strategy, that addresses m any issues such as pharmacotherapy, informing the patient about the co urse and treatment of the illness, and supportive psychotherapy. Speci fic drug treatments are the most important tool in the treatment of bi polar disorder. Lithium is regarded as the drug of first choice for pr ophylaxis against bipolar disorder. In a number of controlled investig ations, lithium has been shown to be preventive and mood stabilising b y substantially reducing the frequency, duration and severity of futur e episodes. Carbamazepine is being used increasingly as an alternative to lithium in patients who fail to respond to lithium prophylaxis. No vel pharmacological alternatives for the prophylactic management of bi polar disorder include valproic acid (sodium valproate), high-dose thy roxine and specific drug combinations (such as lithium and carbamazepi ne or valproic acid). Lithium is the drug of choice for the immediate treatment of acute mania, either on its own or in combination with ant ipsychotics. Alternatives are primarily valproic acid and carbamazepin e. The treatment of the depressive phase is often complicated by the p otential risk of an antidepressant-induced rapid change to a manic pha se. However, the treatment of depression in patients with bipolar diso rder does not generally differ from the treatment of unipolar depressi on.