This is particularly evident with respect to a spouse. If in your practice you see a spouse who suddenly becomes extremely derogatory and accusatory toward the partner, consider the possibility of mania. A history of depressive episodes will help you make the diagnosis. Treatment, usually on an inpatient basis, is imperative for a patient with mania. The best treatment for a manic episode is lithium, the oldest mood stabilizer.
Neuroleptics also are extremely helpful for treating mania.
How to treat the depression, how-ever, is still open to question. Although most experts agree that it is best to try to avoid antidepressants, or to use them short term, this is difficult to do in practice. The monoamine oxidase inhibitor tranylcypromine has been shown to be more efficacious than the tricyclic antidepressant imipramine. The other MAO drugs, phenelzine and isocarboxazid, also seem useful. Patients need to be on a special diet with these drugs.