From the Guidelines
Bipolar disorder treatment should primarily involve a combination of medication, psychotherapy, and lifestyle management, with mood stabilizers like lithium, valproate, or lamotrigine as the foundation, and atypical antipsychotics added for acute manic episodes or maintenance therapy, as supported by the most recent evidence 1. The primary goal of treatment is to manage symptoms, prevent mood swings, and improve quality of life.
- Medications used to treat bipolar disorder include:
- Mood stabilizers: lithium (600-1200mg daily), valproate (750-1500mg daily), or lamotrigine (100-200mg daily) to prevent mood swings
- Atypical antipsychotics: quetiapine, olanzapine, or aripiprazole for acute manic episodes or maintenance therapy
- Psychotherapy, such as cognitive behavioral therapy (CBT) and interpersonal and social rhythm therapy (IPSRT), helps patients recognize mood triggers and develop coping strategies
- Lifestyle management is crucial, including regular sleep schedules, stress management, and avoiding alcohol and recreational drugs Treatment is typically long-term, with medication adjustments as needed based on symptoms, and blood level monitoring necessary for certain medications like lithium to ensure therapeutic levels while avoiding toxicity, as noted in 1 and 1. Key considerations in treatment selection include evidence of efficacy, phase of illness, presence of confounding presentations, side effect spectrum and safety, patient history of medication response, and patient and family preferences, as outlined in 1.
From the FDA Drug Label
As oral formulation for the: Treatment of schizophrenia. Acute treatment of manic or mixed episodes associated with bipolar I disorder and maintenance treatment of bipolar I disorder. Adjunct to valproate or lithium in the treatment of manic or mixed episodes associated with bipolar I disorder.
Bipolar Treatment: Olanzapine is indicated for the acute treatment of manic or mixed episodes associated with bipolar I disorder and maintenance treatment of bipolar I disorder. It can be used as an adjunct to valproate or lithium in the treatment of manic or mixed episodes associated with bipolar I disorder 2.
- Dosage: The recommended starting dose is 10 or 15 mg once daily for adults, and 2.5-5 mg once daily for adolescents, with a target dose of 10 mg/day.
- Risperidone is also indicated for the treatment of acute manic or mixed episodes associated with Bipolar I Disorder, as well as adjunctive therapy with lithium or valproate 3.
From the Research
Treatment Options for Bipolar Disorder
- Mood stabilizers, such as lithium, valproate, and lamotrigine, are the recommended treatment for patients with bipolar disorder 4, 5, 6, 7, 8
- Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are also recommended, but some are associated with weight gain 6, 8
- Antidepressants are not recommended as monotherapy, especially during episodes with mixed features, manic episodes, and in bipolar I disorder 6, 8
Selection of Treatment
- The selection of treatment depends on individual patient characteristics, such as positive family history for bipolar disorder, mania-depression-interval pattern, few previous affective episodes/hospitalizations, high risk for suicide, and comorbidities 5
- Lithium may be effective in treating acute mania and preventing both manic and depressive episodes, especially in patients with a positive family history for bipolar disorder and few previous affective episodes/hospitalizations 5
- Valproate may be more effective as an antimanic rather than prophylactic agent, especially in patients with many previous affective episodes/hospitalizations and psychiatric comorbidities 5
Importance of Early Diagnosis and Treatment
- Early diagnosis and treatment are associated with a more favorable prognosis, but diagnosis and optimal treatment are often delayed by a mean of approximately 9 years following an initial depressive episode 6
- Long-term treatment consists of mood stabilizers, and ongoing management involves monitoring for suicidal ideation, substance use disorders, treatment adherence, and recognizing medical complications of pharmacotherapy 6, 8