Role of newer medications for bipolar disorder

The quest for additional effective therapies for bipolar study commenced in the 1960s, even before regulatory approval of Lithium. This was driven by the recognition that patient response to lithium varied from excellent to poor; thus, significant numbers of patients faced its frequent adverse effects and risks without sustaining any benefit. These needed advances have been slowed by the unusual difficulties of studying bipolar disorder in controlled, rigorously designed protocols. These difficulties are reviewed both from the perspective of their effects on research and on clinical practice. In addition, the results of two blinded, placebo-controlled studies of divalproex in the treatment of acute mania are compared with results from earlier open and comparator studies. The comparisons indicate that open-study results with divalproex and other forms of valproic acid have yielded results quite similar to those observed under rigorous study conditions. Whereas substantial evidence exists regarding the efficacy of divalproex and carbamazepine and their roles in treating patients with bipolar disorder, studies evaluating other putative mood-stabilizing agents and antidepressants in bipolar disorder are few in number and inconsistent in results. With few exceptions, studies of these latter drugs do not provide clear guidelines for treatment.