title: Treatment of bipolar disorder: a complex treatment for a multi-faceted disorder.
abstract: BACKGROUND
  Manic-depression or bipolar disorder (BD) is a multi-faceted illness with an inevitably complex treatment.
  
  
  METHODS
  This article summarizes the current status of our knowledge and practice of its treatment.
  
  
  RESULTS
  It is widely accepted that lithium is moderately useful during all phases of bipolar illness and it might possess a specific effectiveness on suicidal prevention. Both first and second generation antipsychotics are widely used and the FDA has approved olanzapine, risperidone, quetiapine, ziprasidone and aripiprazole for the treatment of acute mania. These could also be useful in the treatment of bipolar depression, but only limited data exists so far to support the use of quetiapine monotherapy or the olanzapine-fluoxetine combination. Some, but not all, anticonvulsants possess a broad spectrum of effectiveness, including mixed dysphoric and rapid-cycling forms. Lamotrigine may be effective in the treatment of depression but not mania. Antidepressant use is controversial. Guidelines suggest their cautious use in combination with an antimanic agent, because they are supposed to induce switching to mania or hypomania, mixed episodes and rapid cycling.
  
  
  CONCLUSIONS
  The first-line psychosocial intervention in BD is psychoeducation, followed by cognitive-behavioral therapy. Other treatment options include Electroconvulsive therapy and transcranial magnetic stimulation. There is a gap between the evidence base, which comes mostly from monotherapy trials, and clinical practice, where complex treatment regimens are the rule.
authors.affiliation: Third Department of Psychiatry, Aristotle University of Thessaloniki, Greece. kfount@med.auth.gr
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Fountoulakis
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
authors.forename: Melina
authors.initials: M
authors.lastname: Siamouli
authors.forename: Marc
authors.initials: M
authors.lastname: Valenti
authors.forename: Stamatia
authors.initials: S
authors.lastname: Magiria
authors.forename: Timucin
authors.initials: T
authors.lastname: Oral
authors.forename: David
authors.initials: D
authors.lastname: Fresno
authors.forename: Panteleimon
authors.initials: P
authors.lastname: Giannakopoulos
authors.forename: George S
authors.initials: GS
authors.lastname: Kaprinis