From the Guidelines
The recommended first-line treatment for bipolar disorder is typically a mood stabilizer, with lithium or valproate being the primary options, as supported by the most recent and highest quality study 1.
Treatment Approach
When managing bipolar disorder, it's crucial to consider the phase of illness, presence of confounding presentations, and the patient's history of medication response, as well as their preferences and those of their family 1.
- For acute mania, lithium (starting at 600-900mg daily, titrated to achieve blood levels of 0.6-1.2 mEq/L) or valproate (starting at 750mg daily, titrated to blood levels of 50-125 μg/mL) is recommended.
- For bipolar depression, lamotrigine may be considered, but the primary approach should focus on mood stabilizers like lithium or valproate, with the addition of an antidepressant if necessary, always in combination with a mood stabilizer 1.
Combination Therapy and Monitoring
Often, combination therapy is necessary, adding an atypical antipsychotic for acute episodes.
- Treatment should be individualized based on the patient's specific symptoms, episode type, and treatment history.
- Regular monitoring of medication blood levels, kidney and thyroid function for lithium, and liver function for valproate is essential, as emphasized in studies focusing on the long-term management of bipolar disorder 1.
Psychotherapy and Comprehensive Approach
Psychotherapy, particularly cognitive behavioral therapy or interpersonal and social rhythm therapy, should complement medication management.
- This comprehensive approach addresses both the biological basis of mood dysregulation and provides coping strategies for this chronic condition, aligning with guidelines that prioritize a multifaceted treatment plan 1.
From the FDA Drug Label
Lithium is indicated in the treatment of manic episodes of Bipolar Disorder. Lithium is also indicated as a maintenance treatment for individuals with a diagnosis of Bipolar Disorder.
The recommended first-line treatment for a patient with bipolar disorder is lithium.
- Lithium is indicated for the treatment of manic episodes of Bipolar Disorder.
- Lithium is also used as a maintenance treatment to reduce the frequency of manic episodes and diminish their intensity 2.
From the Research
Recommended First-Line Treatment for Bipolar Disorder
The recommended first-line treatment for a patient with bipolar disorder includes:
- Mood stabilizers, such as lithium, valproate, and lamotrigine 3
- Anticonvulsants, such as valproate and lamotrigine 3
- Atypical antipsychotic drugs, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine 3
Role of Lithium in Bipolar Disorder Treatment
Lithium is considered a first-line intervention for:
- Maintenance treatment of bipolar disorder 4
- Treatment of mania 4, 5
- Reducing the risk of suicide in patients with bipolar disorder 4, 5 Lithium may also be used in combination with other drugs for the treatment of bipolar depression 5
Administration and Monitoring of Lithium
- Ideal lithium plasma concentration for maintenance and monitoring: 0.6-0.8mmol/L 4
- Need for regular monitoring of renal and endocrine function 4
- Potential advantages of prolonged-release (PR) formulations of lithium, including consistent serum lithium concentrations and improved adherence to therapy 5
- Consideration of single daily administration of lithium to minimize adverse effects and enhance compliance 6