Research on bipolar disorder continues to indicate that recurrent epis
odes of mania end depression have a deteriorative effect on patient fu
nctioning, response to treatment, and prognosis. Lithium is the treatm
ent of choice for both acute affective episodes and long-term maintena
nce, but not all patients respond adequately to lithium therapy. Alter
natives or adjuncts to lithium in acute mania include carbamazepine, v
alproate, electroconvulsive therapy (ECT), and clozapine. For acute de
pression, antidepressants often are added to lithium treatment or used
alone; nonpharmacologic options include For and light therapy. Studie
s suggest that carbamazepine and valproate may be as effective as lith
ium in maintenance therapy and that thyroid supplementation may increa
se response in rapid-cycling patients. Using psychosocial intervention
in addition to maintenance pharmacologic treatment may increase medic
ation compliance, decrease hospitalizations, and increase overall func
tioning.