New treatment options include the anticonvulsants divalproex and carbamazepine, newer antidepressants, neuroleptics, and calcium channel blockers. A review of published studies of the most frequently used combinations of mood-stabilizing agents in bipolar disorder demonstrated that lithium and divalproex appears to be the safest and most efficacious combination, making it the preferred choice. Although polypharmacy can improve response, the use of drug combinations increases the risk of adverse effects and noncompliance.
Noncompliance is the major factor that accounts for treatment failure and risk of relapse.
Many bipolar patients refuse to take their medications because they don't want to give up the euphoric feelings that are part of the manic phase. The treatment of bipolar disorder is a continuing challenge to psychiatrists, partly due to fluctuation in the range of symptoms, cycling from mania to depression, and recurrent cycling. With increased understanding of the disorder, specific subtypes have been identified. Treatment becomes further complicated by targeting treatment to the particular subtype, i.e., classic, euphoric manias, hypomanias with episodes of depression, mixed episodes, or rapid cycling. Lithium has been a mainstay of the treatment of bipolar disorder since the 1950s.