Controversies in the Psychopharmacology of Bipolar Disorder

Few studies have examined the decision-making process for selecting a mood stabilizer or antipsychotic for patients with bipolar disorder. Despite a lack of evidence regarding their efficacy, conventional unimodal antidepressants continue to be used in bipolar treatment regimens. This article examines pharmacologic principles that can facilitate the evidence-based use of mood stabilizers and antipsychotics in patients with bipolar disorder. Choosing therapies for the maintenance of bipolar disorder, clinical decision making upon observation of a partial response, the use of combination therapies, and benefit/harm considerations when choosing a treatment for bipolar depression will be reviewed.

From the Department of Psychiatry, George Washington University School of Medicine, Washington, DC, and the Bipolar Collaborative Network, Bethesda, Maryland (Dr Post); the Bipolar Disorder and Depression Research Program, Veterans Affairs Palo Alto Health Care System, and the Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine, Palo Alto, California (Dr Ostacher); and the Department of Psychiatry and the University Hospital Psychiatric Service, University of Texas Health Science Center at San Antonio (Dr Singh).