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Pharmacotherapy of bipolar disorder: current status and emerging options

EKL Sandlin, Y Gao, RS El-Mallakh

In the treatment of bipolar depression, the debate regarding the utility and safety of antidepressants continues. There are several agents that are available for the treatment of bipolar depression, including US FDA-approved agents such as quetiapine and lurasidone, and non-FDA-approved agents such as lamotrigine, pramipexole, modafinil and armodafinil, and ketamine. Efficacy studies for the use of antidepressants are lacking, but safety concerns are quite real with an increased risk of manias, cycling and chronic irritable dysphoria. Many agents are effective in acute mania, including lithium, several anticonvulsants and every antipsychotic examined. All newer agents being studied for mania are anticonvulsants or second-generation antipsychotics. Most agents, which are effective for acute treatment, appear to be effective in maintenance. Despite many advances in the treatment of bipolar illness, the condition remains severe, with a guarded prognosis.