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Therapy of bipolar disorders

Which medications are the right ones for me?

From different expert groups, guidelines on the medicinal treatment of individuals with bipolar disorders have been summarised. These guidelines take into consideration the various situations in which people with a bipolar disorder may find themselves. It is good if you inform yourself about such guidelines, but more decisive is your individual situation and the discussion with your treating doctor, who will then look into the medication, or the combination of medications, which best suits your situation.

Recommendations in the event of acute manic or mixed episodes

More intensive severity

  • Combination therapy using a mood stabiliser (lithium or valproate) plus an atypical antipsychotic (e.g. olanzapine, quetiapine, risperidone) or plus a typical antipsychotic (haloperidol)
  • Usually, combinations with benzodiazepines are mandatory

Less intensive severity

  • Lithium or valproate alone
  • An atypical antipsychotic with phase-prophylactic characteristics alone
  • If necessary, in combination with mood stabilisers and an atypical antipsychotic
  • If necessary, in combination with benzodiazepines

Recommendations for acute depressive episodes

In general

  • Lithium or valproate or lamotrigene, plus a selective serotonin reuptake inhibitor (SSRI)
  • SSRIs only in combination with a mood stabiliser, but first after adjusting the therapy to the mood stabiliser
  • If necessary, together with a low-dosed co-medication and an atypical antipsychotic
  • If necessary, in combination with benzodiazepines

With psychotic symptoms

  • Additionally, with an atypical antipsychotic
  • If necessary, in combination with benzodiazepines

Recommendations when used as a prophylaxis for possible relapses

Initially as a monotherapy

    Indication depending on the prevalent type of illness:
  • Bipolar I: Lithium is the therapy of choice; if manic episodes are more prevalent, a typical antipsychotic is then the therapy of choice; in the event that depressive episodes are more prevalent, lamotrige is then the therapy of choice
  • Bipolar II: Lithium is the therapy of choice, carbamazepine is the second choice medication and lamotrige the third choice

If a monotherapy proves to be insufficient

  • If an SSRI is used additionally (be careful with antidepressants because of the provocation of a mania!)
    Additionally use an atypical antipsychotic
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