Management and treatment of bipolar disorder

Abstract

This chapter surveys the literature on the pharmacological and psychological management of bipolar disorder. Lithium, valproate, and several dopamine antagonists/partial agonists—in monotherapy or in combination—are the first-line treatments for acute mania. For bipolar depression, lithium, lamotrigine, and quetiapine monotherapy remain the first-line options. The topic of antidepressants in bipolar disorder is controversial. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone, and long-acting antipsychotic formulations represent the principal strategies for maintenance treatment of bipolar disorder. The use of medication in bipolar disorder may benefit from a combined psychological approach in stabilizing symptoms and preventing relapses. Three strategies have shown consistent empirical evidence: group psychoeducation, family-focused therapy, and interpersonal and social rhythm therapy. The evidence supporting cognitive behavioural therapy (CBT) as an adjunctive psychosocial intervention is inconsistent, although ‘third-wave’ CBT approaches are promising. There is preliminary evidence for functional remediation in bipolar disorder patients with neurocognitive impairment.