TREATMENT OF BIPOLAR DISORDER - HOW FAR HAVE WE COME

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.