Alternative therapies for bipolar disorder.

The success of lithium in the treatment of manic-depressive illness has highlighted the problems posed by the minority of bipolar patients who are lithium nonresponders or who suffer severe adverse effects. A number of possible alternative treatments have been proposed, and the evidence in support of their clinical efficacy is evaluated. At this time, only the anticonvulsant carbamazepine can be regarded as a clinically applicable potential alternative to lithium. Further controlled studies are needed before the antimanic and prophylactic efficacy of carbamazepine can be regarded as conclusively established. Other treatment approaches are of considerable theoretical interest and of potential value clinically but need to be more thoroughly evaluated.