The efficacy of lithium carbonate has been demonstrated in the acute treatment of mania and depression as well as in the maintenance treatment. Carbamazepine may be regarded as a good alternative, especially for the acute treatment of mania and for the maintenance treatment. Valproic acid so far has only be demonstrated to be efficacious in the acute treatment of mania. Monotherapy with a mood stabilizer is a first option, but its insufficient efficacy in many patients nevertheless necessitates a combined treatment, with two or even three mood stabilizers or with a mood stabilizer and other psychoactive agents. In the acute treatment of mania, antipsychotics are indicated in case of a severe or psychotic mania and benzodiazepines in severe disorders of sleep or restlessness.
Antidepressants have a role as comedication in the acute treatment of the bipolar depression.