What is the role of combined therapy in the treatment of bipolar affective disorder (manic-depressive illness)?

Updated: May 30, 2019
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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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. [3] 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). [3]

Despite the serious side effects associated with clozapine, the Veterans Administration/Department of Defense (VA/DoD) suggest this drug may be added to existing medications if it was successfully used previously for severe mania or mixed episodes or if other antipsychotic agents are unsuccessful. [3]

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