Medications for bipolar disorders: a review of their therapeutic and pharmacological differences. Part I: from antimanics to euthymics

Abstract

Appropriate treatment of bipolar disorder has been the subject of debate since the first evidence of lithium’s effectiveness in the treatment of mania, presented by Schou in 1954. A great deal has been written since then on the short and long-term safety and efficacy of the drugs used to control the various phases of this disorder. These medications have proven to be substantially different in this respect, for which reason their generic classification as mood stabilizers should be reevaluated.

This review draws on information about these differences, and proposes a new definition of these medications based on placebo-controlled, randomized, double-blind studies: 1) antimanics for those with demonstrated efficacy in controlling manic episodes only; 2) partial stabilizers for those with demonstrated efficacy in controlling manic episodes and in preventing recurrence of mania, or those that are effective in controlling depressive episodes and preventing recurrence of depression, and 3 ) euthymics for this which, used as monotherapy, have proven to be effective in controlling manic, mixed, and depressive episodes and in preventing manic and depressive episodes.

In addition to an updated review of the pharmacotherapy of manic episodes, mixed episodes, rapid cyclers, depressive episodes, and prophylaxis of bipolar disorders, we also present the differences in safety and pharmacological characteristics of the drugs used in bipolar disorder.