Bipolar mood disorder: practical strategies for acute and maintenance phase treatment.
The chronic, complex, and episodic course of bipolar mood disorder presents a formidable challenge to the clinician making a treatment plan. Although numerous therapeutic agents are reported to be efficacious for one or more aspects of bipolar illness, treatment is seldom completely effective and is never curative. The goal of treatment is to modify the symptomatic expression of the illness with the result that fewer, briefer, and milder episodes occur. In pursuit of this goal, the use of multiple medications, polypharmacy, is the rule rather than the exception. This article offers recommendations for treatment strategies based on the phase and stage of the illness. The strategies are organized into algorithms that emphasize the use of mood-stabilizing medications as initial steps in a systematic, iterative approach to treatment. Practical issues related to the use of mood-stabilizing therapies are discussed.
Sachs
G S
GS
Clinical Psychopharmacology Unit, Massachusetts General Hospital, Boston, USA.
D000208:Acute Disease; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects; D018692:Antimanic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001714:Bipolar Disorder / Q000145:classification / Q000188:drug therapy* / Q000523:psychology; D002220:Carbamazepine / Q000008:administration & dosage / Q000009:adverse effects; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008134:Long-Term Care; D008297:Male; D011247:Pregnancy; D011619:Psychotropic Drugs / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D014635:Valproic Acid / Q000008:administration & dosage / Q000009:adverse effects
D000927:Anticonvulsants; D018692:Antimanic Agents; D011619:Psychotropic Drugs; D002220:Carbamazepine; D014635:Valproic Acid