Pharmacological treatment in the early phase of bipolar disorders: what stage are we at?

OBJECTIVE: To review available guidelines, explore treatment strategies currently applied, identify critical issues and propose direction for new developments. METHOD: Literature review based on Medline search and hand search of relevant literature. RESULTS: Pharmacological treatment of the early phase of bipolar disorders lacks specific guidelines. Mood stabilizers are often prescribed after many years of illness, antipsychotic medications are frequently prescribed and often for extensive periods of time, and adherence to medication is relatively poor. In addition, mania is frequently misdiagnosed, and there is limited knowledge on which to base identification of bipolar depression and identification of the initial prodrome to bipolar disorders. CONCLUSIONS: There is an urgent need for more research in the early phases of bipolar disorders to develop means to identify patients earlier and to develop approaches that would address the specific needs of this population in a more adequate manner.