Treating bipolar disorder. Evidence-based guidelines for family medicine.
OBJECTIVE
To provide an evidence-based summary of medications commonly used for bipolar disorders and a practical approach to managing bipolar disorders in the office.


METHODS
Articles from 1990 to 2003 were selected from MEDLINE using the key words "bipolar disorder," "antiepileptics," "antipsychotics," "antidepressants," and "mood stabilizers." Good-quality evidence for many of these treatments comes from randomized trials. Lithium, divalproex, carbamazepine, lamotrigine, oxcarbazepine, and some novel antipsychotics all have level I evidence for treating various aspects of the disorder.


RESULTS
Treatment of bipolar disorder involves three therapeutic domains: acute mania, acute depression, and maintenance. Lithium has been a mainstay of treatment for some time, but antiepileptic drugs like divalproex, carbamazepine, and lamotrigine, along with novel antipsychotic drugs like olanzapine, risperidone, and quetiapine, alone or in combination, are increasingly being used successfully to treat acute mania and to maintain mood stability.


CONCLUSIONS
Bipolar disorder is more common in family practice than previously believed. Drug treatments for this complex disorder have evolved rapidly over the past decade, radically changing its management. Treatment now tends to be very successful.
Department of Psychiatry, University of Toronto, Ont. rmcintyr@uhnres.utoronto.ca
Roger S
RS
McIntyre
Deborah A
DA
Mancini
Peter
P
Lin
John
J
Jordan
D000465:Algorithms; D000927:Anticonvulsants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005194:Family Practice; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D017410:Practice Guidelines as Topic
D000927:Anticonvulsants; D014150:Antipsychotic Agents; D008094:Lithium