Latest therapies for bipolar disorder. Looking beyond lithium.

Effective treatments of bipolar disorder now extend to a panoply of choices that include various anticonvulsants and antipsychotics. Although lithium still has an important role, particularly in "classic" mania and suicide prevention, the other FDA-approved agents are better tolerated and more efficacious for mixed states and rapid cycling. It is not uncommon to use combination therapy for this challenging disorder. The FDA has approved olanzapine, risperidone, and quetiapine in combination with either lithium or divalproex for acute mania and the combination medication of olanzapine and fluoxetine for acute bipolar depression. Maintenance treatments that have received FDA approval include olanzapine and lamotrigine. Off-label use of adjunctive medications may be required to target residual symptoms.