Comparative efficacy and tolerability of drug treatments for bipolar disorder

Lithium has been the backbone of treatment for bipolar disorder for several decades, although recent advances have identified a number of other medica tions that have efficacy in treating various phases of the illness. These i nclude the antiepileptic drugs valproate semisodium (divalproex sodium) and carbamazepine and some new antiepileptic drugs (e.g. lamotrigine and topir amate), and the atypical antipsychotics (e.g. olanzapine, clozapine and ris peridone). Conventional antipsychotics continue to be used frequently in bi polar disorder, although they may be somewhat less effective than other tre atments. Otherwise, to date, none of these treatments have been shown to be consistently more effective than any other, so that drug adverse effects a nd tolerability often dictate which agents are used in an individual patien t. Drugs commonly used for the treatment of bipolar disorder are generally tol erated by most patients in large samples. However, the unique adverse effec t signature of a drug will often suggest that it will be less tolerable in some patients than in others. Identifying a specific treatment for a specif ic patient requires a careful individualised assessment of the risk of adve rse effects for that patient's unique circumstances.