Recent advances in the treatment of bipolar mania, depression, mixed states, and rapid cycling.

New pharmacological agents for the treatment of bipolar disorder are under investigation. Some of the new potential treatments attempt to target specific clinical conditions that constitute particular challenges in the management of bipolar individuals. Typical cases of mania traditionally respond well to lithium, but atypical cases, in particular patients with mixed episodes, tend to respond poorly. The pharmacological treatment of bipolar depression is complicated by the phenomenon of rapid cycling, which may make the clinical management of these patients considerably difficult. New therapeutic agents, including new anticonvulsants, atypical antipsychotics, and calcium channel blockers are currently being examined, and bring the promise of substantial advances in the pharmacological management of bipolar patients. Recent developments in this area are reviewed, with a focus on alternatives for the treatment of refractory mania, bipolar depression, mixed states, and rapid cycling patients.