What are the pharmacologic treatments for mania/hypomania or mixed episodes in 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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Initiate lithium, valproate, carbamazepine, aripiprazole, olanzapine, quetiapine, risperidone, or ziprasidone in patients with mania. [3] In patients with 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. [3]

Researchers have demonstrated a link between a locus on chromosome 21 and patient response to lithium. The study found that a single locus of four linked SNPs on chromosome 21 met genome-wide significance criteria for association with lithium response. Carriers of the SNPs had significantly lower rates of disease relapse than carriers of the alternate alleles. [86]

It is not recommended that topiramate, lamotrigine, and gabapentin be used to treat patients with mania or mixed episodes. [3]

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