Treatment Options in Bipolar Disorder: Mood Stabilizers

Charles L. Bowden, MD

Medscape Psychiatry & Mental Health eJournal. 1997;2(4) 

In This Article

Abstract & Introduction

Response to treatment is as varied as the syndrome itself; persistent symptoms often cause significant morbidity. The mood-stabilizing effects of anticonvulsants such as valproate and carbamazepine have been studied in patients not helped by lithium, the traditional mainstay of treatment. These newer agents appear to be effective in the treatment of bipolar disorder, especially for those patients with rapid cycling, dysphoric or mixed mania, or neurologic abnormalities.

Lithium (Li) was first used to treat manic episodes in the late 1940s, but it was not approved for clinical use in the US until 1970. Despite Li's marked antimanic activity, response to the drug has been inadequate in almost half of patients with bipolar illness. During the decade after Li's introduction, the antimanic and antidepressant effects of the anticonvulsants valproate (VPA) and carbamazepine (CBZ) were found to be therapeutically useful in people with bipolar disorders. Clinical trials subsequently demonstrated that the efficacy of these agents for treating acute mania was comparable to that of Li.[1,2,3] Although substantial evidence exists that Li, VPA, and CBZ control manic episodes, support for their efficacy in controlling acute depression is less conclusive, and there are insufficient data regarding the prophylactic effectiveness of VPA and CBZ.[4] Divalproex and Li are the only FDA-approved therapies for manic episodes.[5]


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