with evidence for efficacy in acute mania include:
I favor incorporating lithium or other antimanic agents
in the regimens of patients with bipolar depression not primarily to guard against antidepressant-induced mania but more for pharmacodynamic synergy--complementary mechanisms of action that collectively may produce more substantial antidepressant effects--especially when the patient's illness course has included manic or hypomanic features in the preceding year.
The long-established antimanic agents
, lithium and valproate, both inhibit PKC function even though they are structurally very dissimilar.
Antidepressants, used by 52% of the patients, were the most common medication, followed by stimulants (41%), antipsychotics (23%), antimanic agents
(23%), and antianxiety medications (8%).
One of 14 who received antimanic agents
relapsed within the first 3 months postpartum, compared with 8 of 13 who were not so treated.