Recommendations for the treatment of bipolar affective disorder

The treatment options for bipolar disorders have substantially increased since the introduction of anticonvulsants as treatment alternatives. This development is highly appreciated due to the fact that lithium is not as effective for all bipolar spectrum disorders as it is for bipolar I disorder. Especially when more atypical features such as rapid cycling or mixed states are present, the anticonvulsants valproic acid and carbamazepine seem to be superior to lithium. However, the question also remains whether mono-therapy with a mood stabilizer is sufficient, especially in acute treatment, or with which antidepressant or neuroleptic it might be combined most favorably. Different treatment strategies were discussed comprehensively at a consensus conference. The results are presented here as recommendations.