Drug Combinations for Mania

With the release of new medications into the armamentarium for the treatment of bipolar disorder,clinicians are required to make prudent treatment decisions in light of insufficient research data forpatients with a difficult-to-control illness. Increasingly, clinicians are turning toward a combination oradjunctive treatment out of necessity. Many studies suggest effectiveness of add-on agents in patientswith mania who are unresponsive to one or more drugs, while only a limited number of controlledtrials actually compare one particular combination regimen to another. Despite this lack of data, therehas been no lack of advice for the clinician from clinical recommendations in the form of expert treatmentguidelines to case reports describing suggestive findings from the off-label use of newer agents.With a particular emphasis on the treatment of mania, this article reviews the clinical data on the individual agents of foreseeable use in combination treatment for bipolar disorder. We suggest beginningwith an agent of established effectiveness when combining medications for the treatment of bipolardisorder.