Mental health

Antipsychotics and mood stabilizers in individuals with bipolar mania

Question 7: In individuals with bipolar mania, are a) antipsychotics, b) mood stabilizers (lithium carbonate, valproate, and carbamazepine) effective and safe?

Management of psychosis and bipolar disorders

  • Population: adults with bipolar mania
  • Interventions:
    • mood stabilizers
    • antipsychotics drugs.
  • Comparison: placebo
  • Outcomes:
    • symptoms severity
    • disability and functioning
    • adverse effects of treatment
    • quality of life
    • mortality
    • treatment adherence
    • users' and families' satisfaction with care.

Recommendation(s)

Haloperidol is recommended in individuals with bipolar mania.
Strength of recommendation: STRONG

Second-generation antipsychotics may be considered as an alternative to haloperidol in individuals with bipolar mania if availability can be assured and cost is not a constraint.
Strength of recommendation: STANDARD

Lithium, valproate, or carbamazepine should be offered to individuals with bipolar mania.
Strength of recommendation: STRONG

In individuals with bipolar mania, treatment with lithium should be initiated only in those settings where personnel and facilities for close clinical and laboratory monitoring are available.
Strength of recommendation: STRONG

In women with bipolar mania planning a pregnancy or pregnant or breastfeeding, lithium and valproate should be avoided. In this group, low dose haloperidol should be considered with caution.
Strength of recommendation: STRONG

Evidence profile

Share