Fast Five Quiz: Bipolar Disorder Practice Essentials

Stephen Soreff, MD


January 19, 2022

The treatment of bipolar disorder is directly related to the phase of the episode (ie, depression or mania) and the severity of that phase. For example, a person who is extremely depressed and exhibits suicidal behavior requires inpatient treatment. In contrast, an individual with a moderate depression who still can work should be treated as an outpatient.

Psychotherapy helps patients with bipolar disorder but does not cure the disorder by itself. All patients with bipolar disorder need outpatient monitoring for both medications and psychotherapy.

Combined therapy with an antipsychotic agent and another antimanic medication is recommended for patients with severe mania or mixed episodes, with or without psychotic features. Thus, lithium, a drug commonly used for prophylaxis and treatment of manic episodes, or valproate may be used in combination with antipsychotic agents (eg, severe mania: olanzapine, quetiapine, aripiprazole, risperidone, or possibly ziprasidone; severe mixed episode: aripiprazole, olanzapine, risperidone, haloperidol, or possibly quetiapine or ziprasidone).

In patients with bipolar disorder who have mixed episodes, initiate therapy with valproate, carbamazepine, aripiprazole, olanzapine, risperidone, or ziprasidone. Consider clozapine, haloperidol, or oxcarbazepine in patients with mania or mixed episodes and consider lithium or quetiapine in those with mixed episodes. Topiramate, lamotrigine, and gabapentin are not recommended to treat patients with mania or mixed episodes. The impetus behind the use of mood-stabilizing medications is to prevent dangerous and often disastrous extreme highs and lows. By doing so, these mediations often preclude the necessity of hospitalization.

Whether administering antidepressants in combination with mood-stabilizing agents or as monotherapy is preferred in patients with bipolar disorder is controversial. Antidepressants in the absence of a mood stabilizer are generally not recommended for patients with bipolar disorder type 1. Among medications with the strongest evidence for efficacy in the acute treatment of depression in bipolar disorder type 1 are the olanzapine-fluoxetine combination, quetiapine, and lamotrigine.

Learn more about the treatment of bipolar disorder.

This Fast Five Quiz was excerpted and adapted from the Medscape article Bipolar Disorder.

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