Treatment-resistant bipolar disorder

Over the last few years, the number of potential pharmacotherapies for bipo lar disorder has greatly expanded. Yet the database for virtually all these newer treatments consists of case reports and case series. Among these new er treatments, recently released anticonvulsants are most promising. Lamotr igine has already shown efficacy for treating bipolar depression, while gab apentin's efficacy has yet to be documented in a controlled study. Alone am ong its medication class, topiramate, another anticonvulsant, is associated with weight loss. Novel antipsychotics are effective in treating acute man ia. With the exception of clozapine, their efficacy as true mood stabilizer s is still unknown. Utilizing combinations of mood stabilizers is common an d appropriate but demands knowledge of potential pharmacokinetic interactio ns. Other approaches far treatment resistant bipolar disorder include high- dose thyroid hormones, calcium channel blockers, electroconvulsive therapy, and omega-3 fatty acids. Finally, the efficacy of adjunctive psychosocial strategies is a topic of active investigation.