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Bipolar disorder: lithium is the best treatment

A long-established drug, lithium, remains the leading treatment for preventing the recurrence of manic episodes in patients suffering from bipolar disorder, even though more recent drugs are available.

Bipolar disorder (previously known as manic-depressive psychosis) is characterised by the occurrence of manic episodes (general overexcitement) and episodes of depression. It generally starts between the ages of 20 and 30 and affects men and women alike. After a first episode, around 40% of patients have a repeat; they are 15 times more likely to commit suicide than the rest of the population. A number of trials have shown the effectiveness of lithium in preventing recurrences of bipolar disorder (in particular manic episodes) and suicides. A lithium overdose is toxic, and so requires close monitoring of its blood concentration.

Valproic acid, carbamazepine and lamotrigine are available as a second resort, but their effectiveness is not well established. They can cause a whole range of adverse effects which can sometimes be serious, and there is sometimes a strong risk of interactions.

Neuroleptics are often prescribed as a sedative for patients in the throes of a manic episode. Olanzapine is the only neuroleptic whose marketing authorisation mentions this indication, but trials have not demonstrated that it represents a therapeutic advance, and it has serious adverse effects. Antidepressants expose patients to increased risks of the recurrence of mania.

In practice, lithium remains the best evaluated and the most effective treatment for preventing acute bipolar disorder episodes.

©Prescrire May 2005

Source: "Prévenir les récidives au cours des troubles bipolaires" Rev Prescrire 2005 ; 25 (261) : 363-366.

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