Drug Interactions of Lithium and Other Antimanic/Mood-Stabilizing Medications

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Treatments for bipolar disorder often consist of a combination of 2 or more medications that have mood-stabilizing properties. Lithium is the only agent that has shown efficacy for the treatment of acute mania and acute depression as well as for the prevention of recurrence of mania and depression in patients with bipolar disorder. Other agents frequently used as mood stabilizers in monotherapy and in combination with lithium are valproate and carbamazepine. Several other drugs that have mood-stabilizing properties are used in many combinations to effectively manage the spectrum of symptoms of bipolar disorder throughout the acute and maintenance phases. However, side effects and drug-interaction precautions accompany all agents used to treat bipolar disorder, and often it can be difficult to determine whether a patient is suffering from side effects of treatment or symptoms of the illness itself. It is important to use the lowest effective dose of any treatment medication, to monitor laboratory values closely, and to be familiar with the side effects and interaction precautions of each medication that a patient is taking. Successful management of medications for the patient with bipolar disorder is a challenge, but increased effort and vigilance by clinicians mean a reduced risk of hospitalization and fewer office visits for patients.

J Clin Psychiatry 2003;64(suppl 5):38-43