1. Mood stabilizers such as lithium and the anticonvulsants are effective for acute treatment as well as the prophylaxis of mood episodes. (Also see Mood Stabilizers, page 112).
2. ECT is very effective for bipolar disorder (depressed or manic episodes), but it is generally used after conventional pharmacotherapy has failed or is contraindicated.
3. Antidepressants may be used for treatment of major depressive episodes, but they should only be used in conjunction with a mood stabilizer to prevent precipitation of a manic episode. Antidepressants may induce rapid cycling.
4. Adjunctive use of antipsychotics (if psychosis is present) or sedating benzodiazepines, such as clonazepam and lorazepam (for severe agitation), may be necessary. Olanzapine (Zyprexa) is FDA approved for the treatment of acute mania. Other atypical antipsychotics are likely to have similar efficacy.
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