Enhancing stability in bipolar disorder

Il valore della stabilizzazione nel disturbo bipolare

P. Girardi, G. Serafini

Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center Sant’Andrea Hospital, Sapienza University of Rome, Italy


Bipolar disorder (BD) is usually diagnosed after a delay of at least 10 years; during this period, bipolar subjects often take inappropriate treatments. The purpose of this overview of the current literature is to provide a specific point of view regarding several critical issues such as diagnosis, management and treatment of this complex illness.


A detailed search of the literature was conducted in Pubmed/ Medline, Scopus, Science Direct, PsycLit and PsycInfo databases to identify all publications in English language from January 1980 to January 2013. The study used the following terms: “Stabilization” and “Management” and “Bipolar Disorder” OR “BD” and “acute treatment” and “maintenance treatment”.


Mood stabilizers are the first-line treatment during manic, hypomanic and mixed episodes of BD. Lithium still represents the gold standard among all the currently available treatments of BD. Most of the available evidence suggests that mood stabilizers are effective in the acute treatment, maintenance and prophylaxis of BD. Quetiapine is the only one among the available second-generation antipsychotics to have an indication in the acute depressive episodes of BD, whereas both quetiapine and lamotrogine are indicated for the prophylaxis of depressive bipolar episodes. These agents can be used as monotherapy but also, more frequently, in combination.


Treatment of BD should be focused on maintenance therapy through the use of mood stabilizers. Antidepressant drugs should be avoided due to the possible induction of rapid cycling and the long-term instability.

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