Skip to main content Accessibility help

Treatment Guidelines for Acute Manic and Mixed Episodes of Bipolar Disorder

  • Mark A. Frye


Bipolar disorder is a lifelong condition, and pharmacotherapy is essential to its long-term management. Once a comprehensive diagnostic assessment for acute or mixed mania has been completed, it is important to look at an evidence-based data set to guide treatment selection for mood stabilization.

For most patients, lifetime adherence to pharmacotherapy is necessary for maximal mood stability. Pharmacotherapy is the primary treatment for bipolar disorder, as it has been found to be efficacious in treating acute episodes and preventing future episodes of bipolar I disorder. Combination therapy, including at least one mood stabilizer, may be necessary to treat acute depression and mania and to further prevent both depressive and manic recurrences. The goal is to minimize frequency, duration, and severity of depressive and manic symptoms with a treatment regimen, ideally a combination of pharmacotherapy and psychotherapy, that is positioned to maximize treatment adherence and minimize side effects.

This discussion reviews some treatment guidelines for acute manic and mixed episodes associated with bipolar I disorder. Through the context of a case study, this discussion will attempt to provide an understanding and appreciation of Food and Drug Administration-approved and non-FDA-approved treatments for acute mania. In addition, the impact of alcohol as an example of drugs of abuse and its impact on the presentation of acute mania will be discussed.



Hide All
1.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
2.Ketter, TA (ed). Advances in the Treatment of Bipolar Disorder. 2005.
3.Swann, AC, Bowden, CL, Morris, D et al. , Depression during mania. Treatment response to lithium or divalproex. Arch Gen Psychiatry. 1997;54(1):3742.
4.Bradwejn, J, Shriqui, C et al. , Double-blind comparison of the effects of clonazepam and lorazepam in acute mania. J Clin Psychopharmacology. 1990;10:403408.
5.Green, A, Tohen, M, Patel, JK et al. , Clozapine in the treatment of refractory psychotic mania. Am J Psychiatry. 2000;157:982986.
6.Frye, MA, Salloum, IM. Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations. Bipolar Disord. 2006;8:677685.
7.Frye, MA, Ketter, TA, Altshuler, LL, Denicoff, K, Cora Locatelli, G, Post, RM. Clozapine in affective illness: implications for other atypical antipsychotics in the treatment of bipolar disorder. J Affect Disord. 1998;48:91104.
8.Regier, DA, Farmar, ME, Rae, DS et al. , Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990;264(19):25112518.
9.Goodwin, FK, Jamison, KR. Manic Depressive Illness. New York, NY: Oxford University Press; 1990.
10.Lasser, K, Boyd, JW, Woolhandler, S et al. , Smoking and mental illness: A population-based prevalence study. JAMA. 2000;284(20):26062610.
11.McKowen, JW, Frye, MA, Altshuler, LL, Gitlin, MJ. Patterns of alcohol consumption in bipolar patients comorbid for alcohol abuse or dependence. Bipolar Disord. 2005;7(4):377381.
12.Salloum, IM, Cornelius, JR, Daley, DC et al. , Efficacy of valproate maintenance in patients with bipolar disorder and alcoholism: a double-blind placebo-controlled study. Arch Gen Psychiatry. 2005;62(1):3745.
13.Brown, ES, Garza, M, Carmody, TJ. A randomized, double-blind, placebo-controlled addon trial of quetiapine in outpatients with bipolar disroder and alchol use disorders. J Clin Psychiatry. 2008;69:701715.

Treatment Guidelines for Acute Manic and Mixed Episodes of Bipolar Disorder

  • Mark A. Frye


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed