Review

Treatment of bipolar disorder: a complex treatment for a multi-faceted disorder

Konstantinos N Fountoulakis¹ , Eduard Vieta² , Melina Siamouli¹ , Marc Valenti² , Stamatia Magiria¹ , Timucin Oral³ , David Fresno² , Panteleimon Giannakopoulos⁴ and George S Kaprinis¹

¹  Third Department of Psychiatry, Aristotle University of Thessaloniki, Greece

²  Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain

³  Fifth Inpatient Department of Psychiatry and Outpatient Unit of Mood Disorders, Bakirköy State Teaching and Research Hospital for Neuropsychiatry, Istanbul, Turkey

⁴  Department of Psychiatry, University of Geneva, Switzerland

author email corresponding author email

Annals of General Psychiatry 2007, 6:27doi:10.1186/1744-859X-6-27

Published:	9 October 2007

Abstract

Background

Manic-depression or bipolar disorder (BD) is a multi-faceted illness with an inevitably complex treatment.

Methods

This article summarizes the current status of our knowledge and practice of its treatment.

Results

It is widely accepted that lithium is moderately useful during all phases of bipolar illness and it might possess a specific effectiveness on suicidal prevention. Both first and second generation antipsychotics are widely used and the FDA has approved olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole for the treatment of acute mania. These could also be useful in the treatment of bipolar depression, but only limited data exists so far to support the use of quetiapine monotherapy or the olanzapine-fluoxetine combination. Some, but not all, anticonvulsants possess a broad spectrum of effectiveness, including mixed dysphoric and rapid-cycling forms. Lamotrigine may be effective in the treatment of depression but not mania. Antidepressant use is controversial. Guidelines suggest their cautious use in combination with an antimanic agent, because they are supposed to induce switching to mania or hypomania, mixed episodes and rapid cycling.

Conclusion

The first-line psychosocial intervention in BD is psychoeducation, followed by cognitive-behavioral therapy. Other treatment options include Electroconvulsive therapy and transcranial magnetic stimulation. There is a gap between the evidence base, which comes mostly from monotherapy trials, and clinical practice, where complex treatment regimens are the rule.