Essential Pharmacotherapies for Bipolar Disorder

Abstract

The evidence basis for treatment of bipolar disorder, both for adults and children, is fairly varied and while Federal Drug Administration (FDA) approval provides one marker of evidence, many psychotropic medications are used for off-label indications. Primary care providers are increasingly at the forefront of initiating treatment for patients with mental health disorders. The purpose of this review is to discuss the current state of evidence for medications treating bipolar disorder, highlighting the evidence, exploring contraindications, side effects, and monitoring requirements for each of the major agents available. Currently, there are three major classes of medication to treat bipolar disorder: lithium, anti-seizure drugs, and a growing range of second-generation antipsychotics. The guiding principle in initiation of treatment is to target treatment to the primary phase of illness while balancing side effect profiles with patient characteristics and comorbidities. While FDA approval of medications for the treatment of bipolar disorder is somewhat limited for both children and adults, in practice, a wider range of medications have shown to be useful. Increasing second-generation antipsychotic medications can be used as first-line agents for both bipolar mania and bipolar depression.