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How should bipolar disorder be treated using medications?

Typically, patients initially present for treatment in the manic, depressed, or mixed phases of bipolar disorder, though some will seek treatment at a time of normal mood (euthymia). Optimal results are obtained by setting therapeutic priorities and introducing medications in the order dictated by those priorities. The acutely manic patient needs to be rapidly brought down to a normal, or at a minimum, mildly hypomanic state so that they are not making decisions or engaging in behaviors that can be destructive. Patients who are in an extremely irritable mixed state need to be rapidly stabilized such that they do not act on or inappropriately express the rage that so often characterizes this mood state, or commit suicide. Depressed patients need to have their depression treated, but without triggering a manic or mixed state as antidepressants so often do.

In my experience, treatment for most bipolar patients is best accomplished in four phases:
  1. Rapidly stabilize mania or mixed states to avoid dangerous or inappropriate behaviors and the long-term consequences of such behaviors.
  2. Introduce agents that are likely to dampen mood cycles and reduce their frequency over time, as opposed to just providing acute suppression of the symptoms of a mania or mixed state.
  3. Address residual depression if it remains after phase 1 and 2.
  4. Address coexisting conditions (anxiety or attention deficit hyperactivity disorder [ADHD] most commonly).

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.