Bipolar disorder
Mood disorder with episodes of mania or hypomania and depression. Treatment relies on mood stabilizers (lithium, valproate, lamotrigine) and atypical antipsychotics.
ICD-10 F314 drugs
Also known as: BD, Manic-depressive disorder
Drugs used for this condition
- ALithiumFirst line · Psycholeptics. LithiumLithium is the first-line maintenance therapy for bipolar disorder type I and II. NICE CG185 2023 and RANZCP 2022 list lithium as the drug of choice for long-term mood stabilization in adults. Reduces manic episodes by 60–70% and depressive episodes by 30–40%. For acute mania, comparable to valproate and atypical antipsychotics. Lithium is unique in reducing suicide risk in bipolar disorder (Cipriani 2013 meta-analysis demonstrated all-cause mortality reduction).
- AQuetiapineFirst line · Atypical antipsychoticsFirst-line for bipolar disorder per CANMAT 2018 and APA 2020. Effective in acute mania, bipolar depression, and maintenance. FDA-approved across acute mania, bipolar depression, and maintenance (maintenance as an add-on to lithium or valproate). Dose 300–600 mg in mania; 300 mg in bipolar depression.
- AValproic acidFirst line · Antiepileptics. Fatty acid derivativesValproate is used for acute mania in bipolar disorder and maintenance therapy. NICE CG185 and RANZCP 2022 list valproate as a first-line option for acute mania alongside lithium and atypical antipsychotics. Efficacy in mania is comparable to lithium per meta-analyses. Not used in women of reproductive age without strict indications.
- BCarbamazepineThird line · Antiepileptics. Carboxamide derivativesIn bipolar disorder, carbamazepine is used as a third-line mood stabilizer after lithium and valproate. NICE CG185 and RANZCP 2022 recommend considering carbamazepine when first-line drugs are intolerable or ineffective. Effective for acute mania and maintenance therapy. Use is complicated by strong CYP induction and drug interaction risk.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit