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Bipolar disorder in adults: Choosing pharmacotherapy for acute mania and hypomania

Author
Jeffrey Stovall, MD
Section Editor
Paul Keck, MD
Deputy Editor
David Solomon, MD

INTRODUCTION

Bipolar disorder is marked by episodes of mania (table 1) and hypomania (table 2), and nearly always includes episodes of major depression (table 3) [1]. Despite clinical differences between manic and hypomanic episodes, for the purpose of treatment they are considered to be similar and thus treated with the same medications [2-5].

This topic reviews pharmacotherapy for acute mania and hypomania in adults. Pharmacotherapy for acute bipolar depression and maintenance treatment are discussed separately. (See "Bipolar disorder in adults: Pharmacotherapy for acute depression" and "Bipolar disorder in adults: Choosing maintenance treatment".)

DEFINITION OF BIPOLAR DISORDER

Bipolar disorder is a mood disorder that is characterized by episodes of mania (table 1), hypomania (table 2), and major depression (table 3) [1]. The subtypes of bipolar disorder include bipolar I and bipolar II. Patients with bipolar I disorder experience manic episodes, and nearly always experience hypomanic and major depressive episodes. Bipolar II disorder is marked by at least one hypomanic episode, at least one major depressive episode, and the absence of manic episodes. Additional information about the clinical features and diagnosis of bipolar disorder is discussed separately. (See "Bipolar disorder in adults: Clinical features" and "Bipolar disorder in adults: Assessment and diagnosis", section on 'Diagnosis'.)

Despite clinical differences among manic and hypomanic episodes (eg, hypomania is less severe than mania), for the purpose of treatment they are considered to be similar and thus treated with the same medications [2-5].

Pharmacotherapy for manic episodes depends upon their severity. Although there are no established criteria that demarcate severe episodes from mild to moderate illness, we classify episodes as severe if they include any of the following:

                                  
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Literature review current through: Nov 2017. | This topic last updated: Nov 30, 2017.
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